Normal Ophthalmologic Examination Research Articles

Efficacy of sulfasalazine on recurrent acute anterior uveitis: a three-year follow-up.

To evaluate the efficacy of sulfasalazine (SSZ) for recurrent acute anterior uveitis (AAU). Retrospectivechartreview ofpatientsdiagnosed withrecurrent AAU treated with SSZfromJanuary2008 toSeptember 2023. Thegrading ofuveitisactivitywasdefined asper SUNworkinggroup. The primary outcome was thereductionin thenumber ofuveitisflare-upsover a one-year, two-year and three year-period,comparedto pre-treatment year.The response criteriato SSZwere defined as normal ophthalmologic examination. Paired samples Wilcoxon test and Kaplan-Meiersurvival curvewerecalculated using R-Commander statistical software (p < 0.05). Fifty-three patients were included. Mean time of follow up was 38.51 ± 38.45months.Nine patients developed adverse effects to SSZ (16.98%) most of them mild. Ankylosingspondylitis was the most frequent association(n = 28,52.83%), while HLA-B27 was positive in 69.23% of the patients (n = 36). The most frequent indication for SSZ was based on ocular activity in 52.83% (n = 28). The number of flare-ups dropped from 2.25 (± 1.34) in the pre-treatment year to, 0.81(± 0.99) at year 1 (p < 0.001), 0.61 (± 0.78) at year 2 (p < 0.001) and 0.65 (± 0.83) at year 3 (p = 0.005).The median time to flare-upof AAUafter SSZwas15.13months(CI 95, 7.97-27.40). Our data point to sulfasalazine as an effective treatmentto reduce flare-upsin patients with recurrentnon-infectious AAU.Itslow cost andgoodsafetyprofilemake it an interestingtherapeuticalternative,especially in women of childbearing age.

Neurodevelopmental outcomes in newborns with birth asphyxia with special reference to hearing and visual impairment

Background: Birth asphyxia, the commonest cause of neonatal hospital admission with involvement of majority of an infant's organs but brain impairment is particularly worrisome. Early, severe neurologic dysfunction indicates significant hypoxic-ischemic insult and is the best predictor of neurologic sequelae. The survivors suffer from hypoxic–ischemic brain injury affecting vulnerable areas of the brain leading to neurodevelopmental sequelae including problems with sensory-motor, auditory and language processing. Methods: This prospective cohort study conducted at Neonatal Section of JNMCH, AMU, Aligarh included 150 asphyxiated newborns fulfilling inclusion criteria. The discharged newborns were followed at 6,10 and 14 weeks and 6 months for neurological assessment using HINES along with screening assessment of visual and hearing. The findings noted compared with different Stages of HIE. Results: Among a total of 150 eligible asphyxiated newborn enrolled in the study, 91 babies were discharged. 89% of the Stage I HIE discharged infant had HINES score of more than 70 at 6 months whereas score of more than 65 was seen in 96%, 81% and 35% in the three advancing stages of HIE respectively. All babies in stage I, 77% of stage II and 50% of stage III babies had normal ophthalmological examination. All babies with stage III had an abnormal hearing. Conclusions: Majority of asphyxiated newborn of Stage I and II were having good hospital as well as neurodevelopment and visual outcome but the Stage III babies had high mortality and adverse neurological, ophthalmic and hearing sequalae in the survivors.

Optic nerve T2-hyperintensity: a nonspecific marker of optic nerve damage (P2-9.004)

<h3>Objective:</h3> To determine the significance of optic nerve (ON) T2-hyperintensity and optic atrophy on MRI. <h3>Background:</h3> The best imaging modality to investigate optic neuropathy etiologies is an orbital MRI. In acute optic neuritis, ON T2-hyperintensity and contrast enhancement (CE) are seen in 77% and 90% of patients, respectively. However, in chronic optic neuropathies, ON T2-hyperintensity and atrophy are typically seen. Interestingly, isolated ON T2-hyperintensity is often presumed to be due to optic neuritis, prompting unnecessary investigations and frequent referrals to neuro-ophthalmology. <h3>Design/Methods:</h3> Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast at our institution between 07/01/2019–06/30/2022. Patients with ON T2-hyperintensity or atrophy were included. Medical records were reviewed to determine the etiology, if any, of the T2-hyperintensity and/or atrophy. <h3>Results:</h3> 491 patients were included (mean age 52±17 years; 57% men). 381/724 ONs had <b>T2-hyperintensity </b><b><i>without</i></b><b> atrophy</b>; diagnoses: inflammatory (100), compressive (94), glaucoma (19), multifactorial (47), other (69), unspecified (15), normal (37). 219/724 ONs had <b>T2-hyperintensity </b><b><i>and</i></b><b> atrophy</b>; diagnoses: inflammatory (36), compressive (50), glaucoma (30), multifactorial (39), other (36), unspecified (12), normal (16). 124/724 ONs had <b>atrophy </b><b><i>without</i></b><b> T2-hyperintensity</b>; diagnoses: inflammatory (13), compressive (12), glaucoma (32), multifactorial (21), other (24), unspecified (7), normal (15). 68/724 eyes with T2-hyperintensity or atrophy had a normal ophthalmologic examination. <h3>Conclusions:</h3> ON T2-hyperintensity on MRI is a non-specific finding; it can be seen in various acute and chronic optic neuropathies. ON T2-hyperintensity <b>with</b> ON atrophy <b>without</b> associated CE can occur secondary to chronic optic neuropathies, such as compressive and glaucomatous optic neuropathies, and is not highly associated with inflammatory optic neuropathies. Therefore, these radiological findings should not automatically prompt an urgent neuro-ophthalmology evaluation or further work-up for optic neuritis, such as a lumbar puncture. However, in the absence of a known cause of the optic neuropathy, an optic neuropathy work-up should be performed. <b>Disclosure:</b> Dr. Labella Alvarez has received research support from Fundación Alfonso Martín Escudero. Dr. Mosleh has nothing to disclose. Dr. Bouthour has nothing to disclose. Amit Saindane has nothing to disclose. Dr. Dattilo has nothing to disclose. Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophoenix. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avidity. Dr. Newman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurodiem. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Chiesi/Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $0-$499 for serving as a Consultant for Neurophoenix. The institution of Dr. Biousse has received research support from NIH. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.

Nine Years' Follow-up of Bilateral Extremely Low Vaulting of Implantable Collamer Lens: Case Report

Purpose: To present a patient with bilateral implantable Collamer lens (ICL) implantation with extremely low vault who was followed up over 9 years and in whom no cataract was detected. Methods: A 56-year-old woman underwent uneventful bilateral ICL implantation and her postoperative ICL vaulting was 10 and 8 µm in the right and left eye, respectively. After consultation with the patient, it was decided to withhold surgical intervention and follow up closely. Results: Nine years postoperatively, the patient had normal ophthalmological examination results: uncorrected distance and near visual acuity of 20/20, normal intraocular pressure and open angle, stable ICL with low vaulting of 8 to 12 µm, clear lens with stable Objective Scatter Index scores, and normal posterior segment. Conclusions: This case report shows that even though low ICL vault is a risk factor for cataract development, withholding surgical intervention should be considered depending on the patient's age, characteristics, and compliance with close follow-up. [ Journal of Refractive Surgery Case Reports. 2023;3(1):e5–e9.]

Prolonged Fever in a Child With Congenital Heart Disease and a Prosthetic Valve.

Prolonged Fever in a Child With Congenital Heart Disease and a Prosthetic Valve.

Characterization of patients with ocular pain evaluated with ultrasound.

The cause of ocular pain in the quiet eye is challenging to diagnose. It is a common complaint in the ophthalmology clinic and there are no actual guidelines on the exams that should be ordered initially. We decided to characterize patients with eye pain and normal ophthalmological examination who underwent ocular ultrasound, their findings, and systemic work-up. A retrospective chart review of patients who underwent ocular ultrasound due to ocular pain and no clinical findings on initial slit-lamp examination. We evaluated patient characteristics and analyzed systemic work-up results in contrast to ocular ultrasound findings. Two hundred and three patients with normal slit-lamp examination and ocular pain were evaluated using ocular ultrasound at Clinica Barraquer. Most of the patients were women (88.7%), and 55% were older than 50 years. Nearly all of the patients had echographic findings, 87.7% of patients showed evidence of scleral scars, from which 66.5% had signs of activity, and 42.9% had thickened extraocular muscles. In general, most patients with ocular pain had normal results on systemic work-up, but the patients who did have positive results tended to have echographic findings. Posterior inflammation is present in most patients with ocular pain in a quiet eye, and echography is an optimal tool to identify this. There is a tendency towards abnormal autoimmune test results and echographic findings. This should be considered in the initial work-up of these patients, given the importance of early diagnosis and the threat of vision loss with severe inflammation.

Cone mosaic characteristics in red-green colour deficiency: a comparative study

ObjectiveTo compare photoreceptor cone characteristics using adaptive optics (AO) technology between congenital colour blind patients and healthy age-matched controls. DesignCross-sectional. Participants21 eyes (21 cases) with congenital red-green colour blindness and 21 eyes of age-matched controls (21 controls), all having a best-corrected visual acuity of 20/20 and normal ophthalmological examination, were recruited. MethodsColour vision testing was done using the Farnsworth–Munsell 100-Hue test and Nagel anomaloscope. Imaging of fovea was done using rtx1 AO retinal camera with a sampling window size of 4° × 4°. Peak cone density, intercone spacing, cone regularity, and cone dispersion were determined using AOdetect Mosaic software. ResultsOverall, mean cone characteristics at 2° off fixation in cases and controls, respectively, were density 26 587 ± 1328/26 448 ± 687 cells/mm2 (p = 0.67), spacing 6.69 ± 0.17/6.75 ± 0.11 μm (p = 0.19), regularity 94.36 ± 2.56/94.83 ± 1.28% (p = 0.46), dispersion 10.22 ± 1.21/11.68 ± 0.79% (p = 0.0001), and hexagonality 50.62 ± 4.21/49.52 ± 2.45% (p = 0.31). No significant difference was noted in various cone metrics except dispersion, which was markedly decreased in colour-deficient individuals. At 4° off fixation, the cone characteristics were not significantly different between cases and controls: density 16 521 ± 1230/16 930 ± 678 cells/mm2 (p = 0.37), spacing 8.60 ± 0.29/8.46 ± 0.17 μm (p = 0.19), regularity 92.68 ± 2.83/92.6 ± 3.05% (p = 0.95), dispersion 13.43 ± 3.48/13.65 ± 2.38% (p = 0.87), and hexagonality 45.22 ± 3.8/45.21 ± 5.5% (p = 0.99). A significant reduction in cone density, regularity, and hexagonality was associated with corresponding increase in spacing and dispersion as we moved from 2° to 4° off fixation in both cases and controls. ConclusionCone photoreceptor characteristics are anatomically well preserved in young colour-deficient individuals except cone dispersion.

84 Ophthalmology exams in suspected child physical abuse: are they overused?

Recent studies suggest that fundoscopic examination may not be necessary in children with suspected physical abuse if the physical exam and neuroimaging show no evidence of intracranial injury. The likelihood of encountering retinal hemorrhages in these children is very low. To review the ophthalmologic examinations conducted in our center in children under 2 years of age with suspected physical abuse. A single-center retrospective chart review was completed using the electronic medical record of the ophthalmology department. We included children aged 0 to 24 months who were evaluated by ophthalmology for suspected physical abuse between May 2014 and June 2018. Charts were identified using the key words “suspected child abuse, physical abuse, shaken baby syndrome, shaken, maltreatment, abuse, retinal hemorrhage, non-accidental injury’’. We excluded children with suspected physical abuse who were not evaluated by ophthalmology. We collected data on patient characteristics, reason for referral, presence or absence of cerebral imaging, results of the imaging and of the ophthalmologic examination, as well as on the timing of these different types of investigations. During the study period, 55 children were evaluated by ophthalmology for suspected physical abuse. The mean age was 6 months, 62% of the children were between the age of 0 and 6 months, and most of the patients were males (67%). Of the 55 children included in our study, 45 children had cerebral imaging. Of those who had cerebral imaging, 30 (66%) did not have any intracranial injuries, and none of these patients had abnormal retinal findings. Conversely, among the 15 with intracranial injuries, 10 had abnormal ophthalmologic exams. Of the 10 children without imaging all had normal ophthalmologic examinations. Of the 45 who had cerebral imaging, 29 had their imaging done before ophthalmologic examination. Of the 29, 12 (41%) had normal imaging and none of these cases were found to have abnormal retinal findings. Of the 16 patients who had ophthalmologic examinations conducted before cerebral imaging, 13 (81%) had both investigations ordered at the same time and 3 (19%) had ophthalmology ordered first. Our study suggests that, in our center, there is some overuse of ophthalmologic examinations in patients with suspected physical abuse and such examinations should not be used as a screening tool for intracranial injury. Optimization of patient trajectory in the investigation of children with suspected physical abuse will be the focus of a future quality improvement project.

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography.

To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity - Snellen's table, color vision test - Ishihara's table, fundoscopy, and retinography - red-free). A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.

Evaluation of apparent diffusion coefficient measurements of brain injury in type 2 diabetics with retinopathy by diffusion-weighted MRI at 3.0 T.

Diabetes is often associated with impairments in brain functioning. However, the injury of specific functioning areas of the brain is not clear. To address this problem, the present study was designed to investigate possible brain functioning change in specific brain areas, particularly in areas associated with vision function, in patients with proliferative and nonproliferative diabetic retinopathy (PDR and NPDR) using the diffusion-weighted imaging technology. Conventional MRI was performed in 45 diabetic patients, 30 of whom had diabetic retinopathy (DR) involvement (half PDR, and half NPDR) and 15 of whom were diabetic patients without retinopathy and with normal ophthalmologic examination. The apparent diffusion coefficient (ADC) values were calculated in the orbitofrontal cortex (OFC), cingulated gyrus, thalamus, dorsomedial and dorsolateral frontal cortex, and corona radiate. The ADC values of the OFC, cingulated gyrus, and visual cortex were significantly increased in patients with PDR and NPDR compared with both patients without retinopathy and the control group (P<0.01). The ADC values of the OFC, cingulated gyrus, and visual cortex were significantly increased in patients with PDR compared with NPDR. The duration of disease and values of hemoglobin A1c were significantly correlated with ADC values of the OFC, cingulated gyrus, and visual cortex, respectively (P<0.01 or <0.05). We observed significantly increased ADC values of the visual center (OFC, cingulated gyrus, and visual cortex), supporting the association between DR and impairment in brain functioning. Diffusion-weighted imaging may serve to assess subclinical neurological involvement in DR, even when brain structural changes are absent.

Reliability and interexaminer agreement for induced tropia test: is normal always normal?

The purpose of this study was to evaluate the reliability of the fixation preference testing with 10 and 20 diopter prisms (Δ) in children without strabismus in order to extrapolate its utility to preverbal children and to determine interexaminer agreement. Fourty children (24 girls, 16 boys) aged between 5 and 16years with normal ophthalmological examination except refractive errors were included in the study. The visual acuity, refractive errors, and orthoptic findings were recorded. The base-down prism fixation test was performed by two experienced examiners with 10Δ and 20Δ. The presence of corrective movement was recorded as positive result separately for each eye. Best-corrected visual acuity was 1.0 bilaterally for all patients. All patients had binocular single vision and stereopsis. First examiner noted bilateral fixation movement in 65% patients with 10Δ and in 57.5% with 20Δ, second examiner in 50% with 10Δ, and in 37.5% with 20Δ. Interexaminer agreement was 42.5% for 10Δ and 54.5% for 20Δ (p<0.01). Both examiners observed the fixation movement to be less frequent in older children. The fixation movement can be absent or seen asymmetrically even in children with equal visual acuity and binocular vision. The rate of fixation movement seemed to be reduced with age possibly due to increased concentration and cooperation of the child. In addition, there was a remarkable interexaminer variability in both tests. It should be borne in mind that the findings of prism-guided fixation preference tests may be misleading in preverbal children.

Is there an association between pseudoexfoliation syndrome and knee osteoarthritis?

The purpose of this study was to investigate whether there is an association between pseudoexfoliation (PEX) syndrome and knee osteoarthritis (OA), and compare to compare patients with PEX and OA to a control group without PEX. This observational case-control study examined 254 subjects: 127 cases with PEX in at least one eye and 127 controls without PEX. A full ophthalmic examination including slit lamp biomicroscopy, gonioscopy, applanation tonometry, pupil dilation, and fundus examination was performed for the diagnosis of PEX. Knee pain was evaluated using a visual analogue scale (VAS). Knee OA was diagnosed according to American College of Rheumatology (ACR) criteria and graded according to the Kellgren and Lawrence (KL) grading scale on radiographic examination. Of the 254 subjects, 171 (67.3%) had severe OA and 83 (32.7%) mild OA. Of the 171 patients with severe knee OA, 93 (54.4%) had ocular PEX and the remaining 78 (45.6%) had normal ophthalmologic examination results. Both the PEX and the control groups contained 127 patients; the number of patients with moderate-severe OA was significantly (p = 0.032) higher in the PEX group as compared to controls: 93 patients (73.2%) in the PEX group and 78 (61.5%) in the control group. VAS score (p = 0.037) and KL grade (p = 0.024) were significantly higher in the PEX group than in controls. As evidenced by the odds ratios (ORs) pertaining to the severity of OA, age (OR = 1.112; 95% confidence interval, CI: 1.054-1.173) and PEX (OR = 2.044; 95% CI: 1.164-3.584) had a significant influence, but gender did not. This study suggests a probable relationship between OA and ocular PEX. Further studies are needed to analyze the molecular basis of this association. Patients with severe knee OA should be informed about the possibility of having PEX and may be referred for ophthalmologic examination.

Oculomotor abnormalities in posterior cortical atrophy: are they different from those in Alzheimer's disease after all?

This scientific commentary refers to ‘Abnormalities of fixation, saccade and pursuit in posterior cortical atrophy’, by Shakespeare et al. (doi:10.1093/brain/awv103). Posterior cortical atrophy (PCA) is a progressive degenerative condition characterized by a gradual loss of visual skills and other posterior cortical functions due to atrophy of parietal, occipital and occipito-temporal brain regions (Lehmann et al. , 2011). It is associated with a relative preservation of memory, language skills and judgement until late in the clinical course. Core features of PCA include partial or complete Balint’s syndrome (simultanagnosia, optic ataxia and ocular apraxia) and Gerstmann’s syndrome (acalculia, agraphia, finger agnosia), along with various combinations of visuo-spatial and visuo-perceptual impairments (Crutch et al. , 2012), apparent despite an otherwise normal ophthalmological examination. In this issue of Brain , Shakespeare et al. (2015) compare and contrast eye movement abnormalities revealed by basic oculomotor tests in patients with PCA, typical Alzheimer’s disease and healthy controls, in order to determine the extent to which abnormalities in basic (lower-order) oculomotor function contribute to visuo-perceptual disturbances in PCA (Shakespeare et al. , 2015). Patients with PCA typically present when they are between 50 and 65 years of age (Crutch et al. , 2012). One of the most important manifestations of PCA is simultanagnosia, an inability to synthesize the overall meaning of a visual scene despite being able to identify its individual elements; this should be suspected when a patient presents with an inability to read pseudo-isochromatic plates, despite intact colour vision (Beh et al. , 2015). The relative rarity of PCA makes it difficult to recruit large cohorts, but recently the number of studies of this disorder, often referred to as the cardinal visual dementia and the most common atypical Alzheimer’s disease phenotype, has been increasing. The study of …

P24 – 2535: Long-term outcome of West syndrome treated with vigabatrin

Objective To determine the long-term outcome of children with diagnosis with West syndrome and received treatment with vigabatrin. Methods A cross-sectional study was conducted. Medical records of all patients diagnosed with West Syndrome from January 1997 to December 2010 were reviewed to collect basic clinical information related to the diagnosis. Each patient's clinical courses, latest neurodevelopment assessment, physical examination, ophthalmologic examination and IQ test were gathered of analysis. Fisher exact test and Wilcoxon rank-sum test were applied for determination of favorable prognostic factors. Results 100 patients were diagnosed with West syndrome during the study period. There were 81 patients (male 55.6% female 44.4%) received vigabatrin and were included into the study. Treatment with vigabatrin was commenced at the age of 1–19 months (mean 5 months). Duration of therapy ranged from 2 to72 months (mean 27.6 months). Follow-up duration ranged from 18 to 200 months (mean 94.2 months). Forty-four (54.3%), 19 (23.5%), and 18 (22.2%) patients responded, partially responded and did not respond to vigabatrin, respectively. Seven patients (8.6%) achieved seizure-free without any medication with seizure-free duration ranging from 6 to 16 years (mean 13 year). Fourteen patients (17.2%) were seizure-free with daily antiepileptic drug therapy. Their seizure-free duration was 3 to 14 years (mean 9.7 years). Twenty-one patients (28.4%) had other type of seizure after discontinue vigabatrin. Normal ophthalmologic examinations, which included Goldman perimetry examination, were obtained in 12 patients. IQ test (WISC III) disclosed normal and subnormal IQ in 11 and 10 patients respectively. Statistical analysis did not demonstrate significant correlation between gender, etiology, age of onset, duration prior to vigabatrin treatment and type of spasms to the favorable outcome (spasm-free without medication, normal IQ). Conclusion Vigabatrin could be considered for treatment of West syndrome with a favorable long-term outcome.

The woman who sees smaller objects: is it psychiatric or neurological?

. Despite its frequent organic etiology, these patients commonly present for psychiatric observation. The following case illustrates the difficulty that may be experienced in differential diagnosis of micropsia. The authors received informed consent to publish her case. An 88-years-old woman, with a previous medical history of treated hypertension, diabetes mellitus, chronic obstructive pulmonary disease and chronic depression was referred to the Urgent Psychiatric Service for a history of micropsia with eight days of evolution. The patient had perception of objects being smaller, but not located at a greater distance, and she denied any changes in the intensity of symptoms over time and any association with other sensory experiences. Concomitantly, she reported an episode of severe and constant headache in the parieto-occipital region. She had no other visual or neurological complaints, and no fever, dysuria, recent changes in bowel habits or history of surgery for retinal detachment. On mental status examination, the patient was calm, oriented in time and space and cooperative. She had preserved insight, neutral mood and no changes of thought. Hallucinations were excluded. Neurological examination revealed intact cognitive function but visual and sensory extinction. No other motor deficits were present and plantar responses were flexor bilateraly. A brain CT scan revealed a right parieto-occipital infarction with significant hemorrhagic transformation. Patient was referred to Neurology and discharged with the diagnosis of micropsia secondary to right parietal-occipital infarction with significant hemorrhagic transformation. Organic causes are the most frequent aetiology of micropsia 2 . Despite this, and probably as a result of the “strangeness” of the complaint, patients are often referred for psychiatric evaluation. Psychogenic micropsias are usually associated with dissociative disorders but could be present in other psychiatric conditions including anxiety, psychotic and addictive disorders 3 . In this case, a psychogenic origin for micropsia was considered based on her psychiatric history and on normal ophthalmologic examination. However, this case illustrates that it is mandatory to perform complete neurological evaluation before posing a psychiatric diagnosis which is mainly an exclusion diagnosis in case of metamorphopsias. The exact pathophysiological mechanism of changes of perception secondary to focal lesions has yet to be elucidated and more studies are needed to determine the risks factors for metamorphopsias and to monitor and predict its progression over time.

A colloid cyst in the fourth ventricle complicated with aseptic meningitis: A case report

Colloid cysts (CCs) are rarely found in the sellar-suprasellar region. Differential diagnosis of CCs is more challenging in this region because many other cystic lesions may locate or invade sellar or suprasellar structures. We present a large and unusual case of sellar-suprasellar CC with extension into the suprasellar, interpeduncular, and prepontine cisterns. This is the first case of sellar-suprasellar CC treated with an endoscopic transsphenoidal approach.A 33-year-old woman presented with a 1-year history of recurrent headaches. Her headaches had been unresponsive to medical treatment for the last 2 weeks. She had normal neurologic and ophthalmologic examinations. Neuroradiologic studies showed a large cystic sellar lesion with extension into the suprasellar, interpeduncular, and prepontine cisterns. The lesion did not show any enhancement, not even in the cyst wall. Her hormonal status was also normal. The cystic lesion was totally resected via a purely endoscopic endonasal approach. There were no complications, and the patient was recovered completely with improvement of her headache. Pathology was consistent with a CC. At 6-month follow-up, magnetic resonance imaging did not show any evidence of the residual or recurrent lesion.Although rarely found in this location, CC should be considered in the differential diagnosis in patients who present with a sellar-suprasellar cystic lesion. Additionally, sellar-suprasellar CC would be a good candidate for the endoscopic endonasal approach.

A 3-Month-Old Girl with Failure to Thrive

This 3-month-old girl was evaluated for failure to thrive and jaundice. She was the 2,685-gram product of a full-term, uncomplicated pregnancy, labor, and delivery to a 21-year-old gravida 2 para 2 (G2P2) woman. Shortly after birth, it became clear the child had signifi cant failure to thrive and jaundice despite multiple manipulations of formula. She had an extensive evaluation after being found to have cholestatic jaundice. Two liver biopsies were performed at an outside hospital, which showed paucity of bile ducts. She had a normal echocardiogram and normal ophthalmologic examination. She was drinking only 15 oz a day of a cow’s milk-based formula, requiring 20 minutes to drink between 1 to 3 oz. There was no history of vomiting, coughing, or choking, but she had intermittent acholic stools. Family history was unremarkable. On exam, she was a scrawny, malnourished-appearing girl. Her weight, length, and head circumference were all well below the 5th percentile, although they had been in the 25th percentile at birth. She had two patches of hyperpigmentation on her back and trunk. She had extremely prominent cheeks but was not dysmorphic otherwise. She was normocephalic.

Common Features of Periocular Tinea

To present the common features of periocular tinea to aid physicians in future diagnosis and therapy of this condition, because superficial fungal infections on the face are often misdiagnosed owing to the diverse morphologies that they manifest. This is especially true of dermatophytoses involving the periocular region. A retrospective review was performed of patients with a diagnosis of periocular tinea who were seen between January 2003 and September 2009 in the pediatric dermatology clinic at St. Louis Children's Hospital. Ten cases of periocular tinea were identified (6 male patients and 4 female patients). Common features included prolonged misdiagnosis (all 10 cases), a normal ophthalmologic examination (all 10 cases), and inappropriate corticosteroid application (7 cases). Loss of the eyelashes occurred in all 10 patients. No cases had evidence of other tinea infections on examination. Only 2 cases had the central clearing classically associated with tinea corporis. Seven patients had a potassium hydroxide preparation and/or culture positive for fungal elements. Lesions improved with topical and oral antifungal treatment in all cases, and patients were able to regrow their eyelashes. Periocular tinea should be considered in the differential diagnosis for periocular inflammation, especially in those patients refractory to therapy for more common conditions. Loss of the eyelashes is characteristic of these fungal infections, similar to the hair loss that occurs in kerions associated with tinea capitis.

MRI and Positron Emission Tomography Findings in Heidenhain Variant Creutzfeldt-Jakob Disease

The typical presentation of Heidenhain variant Creutzfeldt-Jakob disease (CJD) is a rapidly progressive visual loss in the setting of a relatively normal ophthalmologic examination. At presentation, patients with this uniformly fatal illness frequently demonstrate only minor cortical abnormalities on MRI. Here, we document the clinical presentation and imaging results of a patient with Heidenhain variant CJD in whom abnormalities on positron emission tomographic imaging were more evident than changes on MRI. These changes were present in striate cortex and visual association areas, providing clinical-anatomical correlation with our patient's visual deficits. Nuclear imaging provides a considerably more sensitive measure of neural dysfunction early in the course of this disease.

Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) in the early stages of Alzheimer’s disease

Alzheimer’s disease (AD) is one of the most common causes of dementia in the world. Patients with AD frequently complain of vision disturbances that do not manifest as changes in routine ophthalmological examination findings. The main causes of these disturbances are neuropathological changes in the visual cortex, although abnormalities in the retina and optic nerve cannot be excluded. Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) tests are commonly used in ophthalmology to estimate bioelectrical function of the retina and optic nerve. The aim of this study was to determine whether retinal and optic nerve function, measured by PERG and PVEP tests, is changed in individuals in the early stages of AD with normal routine ophthalmological examination results. Standard PERG and PVEP tests were performed in 30 eyes of 30 patients with the early stages of AD. The results were compared to 30 eyes of 30 normal healthy controls. PERG and PVEP tests were recorded in accordance with the International Society for Clinical Electrophysiology of Vision (ISCEV) standards. Additionally, neural conduction was measured using retinocortical time (RCT)—the difference between P100-wave latency in PVEP and P50-wave implicit time in PERG. In PERG test, PVEP test, and RCT, statistically significant changes were detected. In PERG examination, increased implicit time of P50-wave (P < 0.03) and amplitudes reductions in P50- and N95-waves (P < 0.0001) were observed. In PVEP examination, increased latency of P100-wave (P < 0.0001) was found. A significant increase in RCT (P < 0.0001) was observed. The most prevalent features were amplitude reduction in N95-wave and increased latency of P100-wave which were seen in 56.7% (17/30) of the AD eyes. In patients with the early stages of AD and normal routine ophthalmological examination results, dysfunction of the retinal ganglion cells as well as of the optic nerve is present, as detected by PERG and PVEP tests. These dysfunctions, at least partially, explain the cause of visual disturbances observed in patients with the early stages of AD.