Occurrence Of Visual Field Defects Research Articles

Surgical indication of pediatric Rathke's cleft cyst based on a 20-year retrospective cohort.

Rathke's cleft cyst (RCC) is the most commonly encountered pituitary incidentaloma in children. Because RCC is not frequently diagnosed in children, there are few reports on pediatric RCCs. The natural course of the disease and appropriate treatments are still obscure. The present study aimed to elucidate the natural history and surgical indications of RCCs in children. The authors retrospectively reviewed the clinical presentations, imaging features, ophthalmological evaluations, endocrine evaluations, and surgical outcomes of pediatric RCCs at a single institution from January 2000 to October 2022. Clinical outcomes between the surgery and observation groups were compared. Among 93 patients, there were 41 patients in the surgery group and 52 patients in the observation group. The mean age at diagnosis was 10.9 years, and the mean follow-up period was 5.6 years. Headache fully or partially improved after surgery (86.2%), but the rate of improvement was not different from that of the observation group (70.0%). Ophthalmological abnormalities were effectively improved by surgical treatment (93.3%). Both the improvement and deterioration rates of endocrine abnormalities were significantly higher in the surgery group (p = 0.026 and p < 0.001, respectively), but the deterioration rate (43.9%) was higher than the improvement rate (14.6%). In the surgery group, the recurrence rate was 17.1% and the reoperation rate was 4.9%. Compared with total cyst wall resection, cyst fenestration with partial wall resection was associated with a higher recurrence rate (26.9%, p = 0.035) but a lower rate of endocrine abnormalities (30.8%, p = 0.049). Pediatric RCCs of ≥ 10 mm in size were analyzed. Ophthalmological abnormalities are the major surgical indications for pediatric RCCs. Headache and partial endocrine abnormalities may be improved with surgery, but they are not absolute indications for surgery. Cyst fenestration with partial wall resection via an endoscopic endonasal approach is the most recommended surgical method. Follow-up is essential to monitor for the occurrence of visual field defects and the recurrence of cysts.

This issue of ACTA

This issue of ACTA

Retinal nerve fibre layer thickness in association with gamma zone width and disc-fovea distance.

Previous studies have shown that the retinal nerve fibre layer (RNFL) thickness as surrogate of the optic nerve decreases with longer axial length. We explored which explanatory parameters might explain that association. Participants of the population-based Beijing Eye Study 2011 without any retinal or optic nerve disease were selected based on a refractive error-based stratified randomization. The study included of 632 participants (age: 59.1 ± 7.3 years; axial length: 23.5 ± 1.2 mm; range: 20.88-28.68 mm). Thicker RNFL (mean: 101.0 ± 10.0 μm) was associated (multivariable analysis) with smaller parapapillary gamma zone (defined as Bruch's membrane-free parapapillary region) (standardized regression coefficient beta: -0.13; non-stadardized regression coefficient B: -0.008; 95% confidence interval (CI): -0.014, -0.003; p = 0.005) and shorter disc-fovea distance (beta: -0.15; B: -3.91; 95% CI: -6.60; -1.22; p = 0.004), after adjusting for age (beta: -0.22; B: -030; 95% CI: -0.41, -0.19; p < 0.001), gender (beta: 0.12; B: 2.37; 95% CI 0.77, 3.97; p = 0.004) and larger optic disc area (beta: 0.12; B: 0.12; 95% CI: 2.14; 95% CI: 0.54, 3.73; p = 0.009). RNFL thickness decreased by 8 μm (95% CI: 3, 14) for each mm increase in gamma zone width, and by 3.91 μm (95% CI: 1.22, 6.60) for each mm elongation of the disc-fovea distance. If disc-fovea distance and gamma zone width were replaced by axial length, the latter was correlated with RNFL thickness (beta: -0.37; B: -3.12; 95% CI: -3.88, -2.35; p < 0.001). Longer disc-fovea distance was directly associated with larger gamma zone (beta: 0.50; B: p < 0.001). The RNFL thickness decrease with longer axial length is associated with a longer optic disc-fovea distance and larger parapapillary gamma zone. Longer disc-fovea distance and larger gamma zone lead to an elongation and stretching of the retinal nerve fibres, potentially causing a thinning or loss of the nerve fibres. It may explain the occurrence of visual field defects in some non-glaucomatous highly myopic eyes without macular correlates of the perimetric defects.

Homonymous visual field defect and retinal thinning after occipital stroke

IntroductionStroke is the most common cause of homonymous visual field defects (VFD). About half of the stroke patients recover from VFD. However, relationship between VFD and retinal changes remains elusive.PurposeTo investigate the association between occurrence of VFD, changes of macular ganglion cell and inner plexiform layer (GCIPL) and its axon retinal nerve fiber layer (RNFL) detected with optical coherence tomography (OCT).Patients and methodsThe study consists of retrospective review of medical records and follow‐up examinations. Patients with acute occipital stroke were registered. VFD was identified with confrontation and/or perimetry tests at the onset. At follow‐up, the patients were examined with visual field tests and OCT measurements.ResultsThirty‐six patients met the inclusion criteria. At onset, 26 patients (72%) had VFD. At follow‐up >1 year after stroke, 13 patients (36%) had remaining VFD: 5 had homonymous hemianopia, 5 had homonymous quadrantanopia, and 3 had homonymous scotomas. Average thickness of GCIPL and RNFL were significantly reduced in each eye in patients with VFD compared to non‐VFD (NVFD) (p < .01 for all comparisons). Thickness of superior and inferior RNFL quadrants was significantly reduced in VFD compared to NVFD (p < .01 for both). Among these 13 patients, 4 had characteristic homonymous quadrant‐GCIPL thinning, 2 had characteristic homonymous hemi‐GCIPL thinning, and 7 had diffuse GCIPL thinning.ConclusionGCIPL and RNFL thinning were observed in the patients with VFD. GCIPL thinning appears in two forms: atypical diffuse thinning, or homonymous hemi‐GCIPL thinning. Examining GCIPL and RNFL provides easy and reliable objective measures and is therefore proposed to be of predictive value on visual function.

Multi-scale image analysis and prediction of visual field defects after selective amygdalohippocampectomy

Selective amygdalohippocampectomy is an effective treatment for patients with therapy-refractory temporal lobe epilepsy but may cause visual field defect (VFD). Here, we aimed to describe tissue-specific pre- and postoperative imaging correlates of the VFD severity using whole-brain analyses from voxel- to network-level. Twenty-eight patients with temporal lobe epilepsy underwent pre- and postoperative MRI (T1-MPRAGE and Diffusion Tensor Imaging) as well as kinetic perimetry according to Goldmann standard. We probed for whole-brain gray matter (GM) and white matter (WM) correlates of VFD using voxel-based morphometry and tract-based spatial statistics, respectively. We furthermore reconstructed individual structural connectomes and conducted local and global network analyses. Two clusters in the bihemispheric middle temporal gyri indicated a postsurgical GM volume decrease with increasing VFD severity (FWE-corrected p < 0.05). A single WM cluster showed a fractional anisotropy decrease with increasing severity of VFD in the ipsilesional optic radiation (FWE-corrected p < 0.05). Furthermore, patients with (vs. without) VFD showed a higher number of postoperative local connectivity changes. Neither in the GM, WM, nor in network metrics we found preoperative correlates of VFD severity. Still, in an explorative analysis, an artificial neural network meta-classifier could predict the occurrence of VFD based on presurgical connectomes above chance level.

Clinical study of visual field defects (VFD) in traumatic brain injury (TBI)

Purpose: To determine the frequency of occurrence of visual field defect in a visually symptomatic patients with traumatic brain injury. Materials and Methods: A study was conducted at our institution on 40 patients with history of traumatic brain injury. Study was for a duration of one year from june-2018 to May-2019. Patients with detailed clinical information were included and was subjected to visual field analysis. Results: Out of 40 cases, 32(80%) were males and 8(20%) were females. Age distribution varied from 10–62 years, with 18-45 years being most common. 16(40%) patients had one of the targeted defect. Of which, 8(50%) had scattered scotomas, 3(18%) had Right & 3(18%) had Left homonymous hemianopia, 2(12%) had bi-temporal hemianopia with chiasmal injury. Most frequent defects in the TBI were scattered scotomas next to homonymous hemianopia. Conclusion: Uniqueness of this study is that, it reports frequency of visual field defect in traumatic brain injury. Most were motor vehicle?related, younger male patients. Findings should alert and make one aware of the adverse effects on quality of life and rehabilitation. Keywords: Visual field defects (VFD), Traumatic brain injury (TBI).

Optic Radiation Tractography and Visual Field Deficits in Laser Interstitial Thermal Therapy for Amygdalohippocampectomy in Patients with Mesial Temporal Lobe Epilepsy

Background/Aims: Laser interstitial thermal therapy (LITT) has become an alternative to open-resective surgery for refractory mesial temporal lobe epilepsy (MTLE). Occurrence of visual field defects (VFDs) following open surgery for MTLE is reported at 52-100%. We examined the rate of VFDs following LITT for amygdalohippocampectomy (AHE) and correlated the occurrence of VFDs with damage to the optic radiations, assessed by diffusion tensor tractography (DTI). Methods: We performed a retrospective analysis of 5 patients who underwent LITT-AHE for medically refractory MTLE. We examined the association between VFDs and optic radiation damage by correlating postprocedural visual field testing with qualitative assessment of optic radiation fiber tracts. Results: Postoperative assessments showed that 4 patients had normal visual field testing, and 1 had a right superior quadrantanopsia (20%). We performed 3-dimensional reconstruction of the optic radiation, laser probe trajectory, and ablation volume. Damage to Meyer's loop was determined consistent with the VFD. Conclusions: Short-term follow-up in our series suggests that laser ablation AHE may be associated with a lower rate of VFD than has been reported for open AHE. Our results suggest that incorporating optic radiation mapping through DTI may preoperatively help to minimize the risk of VFD following laser ablation AHE.

Relationship between Retinal Nerve Fiber Layer with Visual Field Defect in Non Proliferative Diabetic Retinopathy

Background: In the early stages of diabetic retinopathy, neuronal abnormalities include changes in ganglion cell death. Neuronal apoptosis is suspected as one of the causes responsible for the occurrence of lesions at an early stage of diabetic retinopathy, which results in a decrease in number of ganglion cells and thinning of the layer of ganglion cells, which can be caused by several mechanisms including glutamat excitoxicitate, oxidatice stress, hyperglichemia, and neuroinflamation. Retinal ganglion cell death and axonal degeneration, will cause thinning of the retinal nerve fiber layer (RNFL) which may result in a decrease in neural function, which in turn have an impact on the occurrence of visual field defects. This study is to determine the relationship between the thickness of RNFL with visual field defects in patients with non-proliferative diabetic retinopathy (NPDR). Methods: This study is a comparative analytic cross-sectional design with sample of 66 eyes of 34 people in clinic of retina subdivision of Moh. Hoesin Hospital Palembang from July to November 2013. Patients of NPDR examined fundus photo, Oculo Coherence Tomograph and Humphrey Field analyzer. Results: RNFL thickness average in this study is 104.4±10.9 μm. Visual field defect occur ini moderate and severe NPDR. Conclusion: There is a strong relationship between RNFL thickness with visual field defects in patients NPDR (r =-0.693). Keywords: RNFL thickness, visual field defect, NPDR Â

Novel screening method for glaucomatous eyes with myopic tilted discs: the crescent moon sign.

To our knowledge, there is no reliable screening method for glaucomatous eyes with myopic tilted discs. To evaluate the diagnostic ability of a novel screening modality, the crescent moon (CM) sign, defined as the discontinuity between the superior or inferior optic rim margin and the temporal optic rim margin, for the detection of glaucomatous eyes with myopic tilted discs. The study was cross-sectional and conducted in a hospital setting from November 1, 2011, to November 1, 2013. Seventy eyes of 70 individuals with early open-angle glaucoma (mean deviation greater than -6 dB) and 70 eyes of 70 normal control participants who had myopic tilted discs were recruited. Another independent group consisting of 60 eyes of 60 individuals with early glaucoma and 60 eyes of 60 normal control participants was enrolled. Two masked glaucoma specialists independently assessed the optic disc on stereoscopic disc photography. The diagnostic performance of the CM sign was evaluated in comparison with violation of the ISNT rule (inferior ≥ superior ≥ nasal ≥ temporal order of configuration for disc rim thickness in normal eyes) and the modified ISNT rule (application of the ISNT rule based on the long axis of the disc). Sensitivity and specificity of the CM sign. The CM sign was more frequently observed in the inferotemporal optic rim margin than in the superotemporal optic rim margin. In a comparative evaluation of the glaucoma diagnostic sensitivity and specificity, the CM sign showed higher sensitivities (90.0%-91.4%) than the ISNT rule (73.3%-75.7%) or the modified ISNT rule (68.6%-70.0%). The CM sign also showed higher specificities (82.9%-83.3%) than the ISNT rule (68.3%-71.4%) or the modified ISNT rule (76.6%-80.0%). Furthermore, the CM sign was shown to be associated with the occurrence of visual field defects in the corresponding hemifield (P < .001). The CM sign can be a useful screening tool for the detection of early glaucoma with myopic tilted discs.

Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm

To estimate prospectively late ocular manifestations in patients after aneurysmal subarachnoid hemorrhage (SAH) treated with aneurysm clipping. Forty-six patients (12 men and 34 women), 23-69 years of age, were included in this study. A conventional ophthalmological examination, visual evoked potentials (VEPs), and static perimetry were performed on all patients. The mean interval between the onset of SAH and the aforementioned examination was 1.9 ± 1.3 years (range 0.5-5 years). The following were compared between patients with affected and non-affected visual fields as well as between those with normal and abnormal VEPs: sex, age, time from SAH to surgery, Hunt and Hess scale, Glasgow Coma Scale, Glasgow Outcome Scale, grading of SAH according to the Fisher scale, and the size and site of aneurysm. Visual field defects were found in 23 patients (50%). In all of these patients, both eyes were affected. The most frequent type of visual field defects were: constricted field (47.8%), multiple peripheral foci (26.1%), and superior field defect (17.4%). There was no significant relationship between the analyzed factors and the occurrence of visual field defects, although statistical significance was almost observed in respect to the Fisher scale (p = 0.055). Deterioration in VEPs was observed in nine patients (19.6%). In the group of patients with abnormal VEPs, the time from onset of SAH to surgery was 2.6 ± 1.8 days, whereas in the group of patients with normal VEPs this time amounted to 6.4 ± 2.4 days (p = 0.02). In patients with no changes in VEPs, the mean Fisher score was significantly higher than in the group with abnormal VEPs (2.8 ± 0.6 vs 2.0 ± 0.4 respectively, p = 0.04). Visual field defects and VEP deterioration are frequent late ocular manifestations of SAH treated with aneurysm clipping. Damage to the visual pathway correlates with the severity of SAH and timing of aneurysmal surgery.

The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: A retrospective analysis

Background The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA). Methods The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined. Results In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each. Conclusion The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.

Limitations of the Heidelberg Retina Tomograph

Glaucoma is a progressive optic neuropathy where damages that occur at the optic nerve head and the retinal never fiber layer are associated with changes in the visual field. The Heidelberg Retina Tomograph (Heidelberg Engineering, Carlsbad, CA), a scanning laser ophthalmoscope, performs a three-dimensional topographic analysis of the optic nerve head and the retinal never fiber layer. The Heidelberg Retina Tomograph has been reported to be a reliable and objective method of identifying structural changes prior to the occurrence of visual field defects. In our series of patients, all had significant visual field defects but normal Heidelberg Retina Tomograph results, including rim area and Moorfield regression analysis. It is important to recognize that interpreting the Heidelberg Retina Tomograph results alone may be misleading; however, when combined with careful clinical evaluation of the optic nerve head and the visual field, the Heidelberg Retina Tomograph may provide valuable information in assisting the clinician with the diagnosis and management of glaucoma.

Visual Field Defects in Epidemic Dropsy

Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana (prickly yellow poppy) seeds as an adulterant of wheat flour or more commonly of cooking oil such as mustard oil. Purpose. To investigate the occurrence of visual field defects in patients suffering from epidemic dropsy glaucoma. Methods. Visual field analysis was performed to ascertain the field defects, in patients suffering from epidemic dropsy. Group I consisted of 35 patients (69 eyes) whose intraocular pressure (IOP) was ≥22 mmHg. Ten dropsy patients (20 eyes) with normal IOP (<22 mm Hg) formed Group II. Ten healthy unexposed volunteers (20 eyes) constituted Group III. All the patients were tested using the Armaly full field glaucoma screening test on the Humphrey field analyzer. Results. Forty seven of the 69 eyes (68%) suffering from epidemic dropsy glaucoma, and 18 out of 20 (90%) eyes in dropsy patients with normal IOP, showed field defects. In the control group, 15% eyes had only nasal field defects. The difference between Group I and II was not significant (p = 0.054), though the field defects were significantly more frequent in dropsy patients as compared to the controls (p ≤ 0.01 in either case). The results suggest that visual field defects in epidemic dropsy occur independently of the rise in intraocular pressure. Field defects were detected more frequently in patients who underwent visual field analysis early in the course of disease, as compared to those who underwent screening later on in the disease course. Conclusions. In epidemic dropsy, acute visual field defects occur independent of rise of intraocular pressure and more frequently in the early stage of the disease.

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.

Visual field defect after pars plana vitrectomy

Objective This study aimed to report the occurrence of visual field defects after pars plana vitrectomy (PPV) for the treatment of each of the following conditions: macular hole (MH), subretinal neovascular membrane (SRNVM), and epiretinal membrane proliferation (EMP). This study also aimed to speculate on the pathogenic mechanisms for the observed field defects. Design Noncomparative case series. Participants The study included 48 subjects (50 eyes). Twenty-one of the 50 eyes had stage III MH, 13 eyes had SRNVM, and 16 eyes had EMP. Testing Goldmann kinetic perimetry was performed postoperatively. Main outcome measure Visual field defects. Results Nine (18%) of the 50 eyes had visual field defects. Four (19%) of the 21 eyes with MH and 5 (38%) of the 13 eyes with SRNVM had visual field defects. Of the 16 patients who had epiretinal membrane peeling, none had a visual field defect. An air-fluid exchange had been performed in all patients found to have a postvitrectomy field defect. The difference in rate of visual field defects in eyes that had air-fluid exchange (EMP group) was statistically significant ( P < 0.05, chi-square). No significant correlation was found between visual field defect and preoperative intraocular pressure, postoperative intraocular pressure, patient’s age, and iatrogenic detachment of the vitreous cortex. The field defects identified were altitudinal (2 eyes), baring of the blind spot (1 eye), inferotemporal (3 eyes), inferonasal (2 eyes), and superonasal (1 eye). Conclusions Central and peripheral visual field defects may occur after PPV for the treatment of MHs or SRNVMs. Air-fluid exchange procedure was the common denominator in all of the patients found to have visual field deficit. The etiology is likely to be trauma to the optic nerve region during the air-fluid exchange procedure.

Homonymous Hemianopsia: Assessment and Nursing Management

1JOYCE H. JOHNSON, R.N., M.S.N., is an assistant professor, University of Illinois College of Nursing, Chicago. She has practiced in acute care settings, and for the past five years has taught nursing of patients with chronic disabilities 2MAURA CRYAN, n.N., M.S.N., is an assistant professor, University of Illinois College of Nursing. She has had two years experience as a member of a rehabilitation team in a general hospital and four years experience as an instructor teaching nursing of patients with chronic disabilities Ms. Johnson and Ms. Cryan are studying the frequency of occurrence of visual field defects in brain-demaged patients and nurses' ability to assess this problem.