Visual Disturbances Research Articles

Subependymal Giant Cell Astrocytoma in an Adult Without Tuberous Sclerosis: Systematic Review & Illustrative Case Example

Background Subependymal Giant Cell Astrocytoma (SEGA) is a rare neoplasm arising from subependymal tissue. Predominantly associated with the tuberous sclerosis complex (TSC), SEGA may present with a range of diverse symptoms, most commonly seizures or neurocutaneous features of TSC. We present a novel case of sporadic SEGA in a 59-year-old woman who presented with acute intraparenchymal hemorrhage. Methods Systematic literature review and illustrative case example. Results A 59-year-old woman presented with a headache and decreased level-of-consciousness, and acute intraparenchymal hemorrhage involving the anterior septum pellucidum and right medial caudate head. MRI was concerning for an underlying neoplasm, which grew slowly on follow-up imaging, prompting microsurgical resection. A gross total resection was achieved, and postoperative pathology confirmed SEGA (WHO Grade I) without TSC1/2 mutation. She remained disease-free and neurologically intact at 1-year follow-up. A systematic review identified 7 publications that revealed pathologically-confirmed SEGA in 9 adult patients without TSC. Headache, papilledema, and visual disturbances were the most common presenting symptoms. Treatment protocols included microsurgical resection versus biopsy followed by radiographic surveillance, and the overall rate of symptom-free survival was at least 80% as of last follow-up. Conclusion We report the 10th case of sporadic SEGA in an adult patient without TSC, as well as an associated systematic review on this rare neoplastic entity. Further study is required to identify risk factors for the development of sporadic SEGA, as well as potential avenues for management of this disease that may depart from the standard protocol in pediatric TSC patients.

Influence of preoperative variables on the 3-month functional outcomes of the Vivity extended depth-of-focus intraocular lens: a prospective case series

BackgroundTo investigate the functional results of the AcrySof IQ Vivity (Alcon, Fort Worth, TX) extended depth-of-focus intraocular lens (EDoF-IOL) and explore correlations between the preoperative biometric parameters and the postoperative functional outcomes.MethodsIn a prospective, single-center, non-randomized study, axial length, keratometry, anterior chamber depth, scotopic and photopic pupil diameters, pupil decentration, corneal asphericity, corneal higher-order aberrations (HOAs), coma and spherical aberration were measured preoperatively. The EDoF-IOL was implanted bilaterally. Three months postoperatively, manifest refraction, monocular and binocular uncorrected and corrected visual acuity at 4 m, 66 cm and 40 cm, binocular defocus curve, binocular contrast sensitivity, halometry and Strehl ratio were measured. Visual disturbances and spectacle independence were assessed with McAlinden and IOLSAT questionnaires, respectively. Assuming a minimum Pearson r correlation coefficient between variables of 0.5 with a power of 80% and a P value less than 0.05, a minimum sample size of 29 (58 eyes) cases was required.ResultsForty-three patients were enrolled. Binocular distance corrected visual acuity was lower than 0.1 logMAR for a defocus between + 1.0 and − 1.5 D. The mean values at 66 cm and 40 cm were − 0.07 ± 0.06 and 0.19 ± 0.13 logMAR, respectively. McAlinden’s questionnaire revealed mean scores close to zero for all questions. The IOLSAT questionnaire showed that spectacles were never used for distance and intermediate vision. Regression analysis did not disclose any significant correlation between the preoperatively measured variables and the postoperative outcomes, with a few exceptions: preoperative higher order corneal aberrations were correlated to halometry area (r2 = 0.2592, P = 0.0006) and the Q value to contrast sensitivity (r2 = 0.1717, P = 0.00574) under photopic conditions with glare at a spatial frequency of 18 cpd and without glare for all spatial frequencies (P < 0.01); it was also correlated to contrast sensitivity under mesopic conditions without glare at a spatial frequency of 12 cpd (r2 = 0.2311, P = 0.0011).ConclusionsIn healthy unoperated eyes, the visual outcomes for this EDoF-IOL are independent of most of the patients’ preoperative parameters. Attention should be paid to preoperative corneal aberrations and asphericity, which did not lead to visual disturbances, but may be potential sources of halo and reduced contrast sensitivity.

Patient-Reported Outcomes of Visual Disturbances with a Trifocal Intraocular Lens: A Meta-Analysis.

Diffractive trifocal intraocular lenses (IOLs) provide good vision at distance, intermediate, and near, but can also cause positive dysphotopsias. This meta-analysis pooled published evidence on visual disturbances after bilateral implantation of the PanOptix (TFNTXX) IOL for patients undergoing cataract surgery. A systematic literature search was conducted in PubMed and congress presentations from April 2021 to December 2022 to identify studies with patient-reported outcomes on the incidence of visual disturbances (starbursts, halos, glare) post bilateral implantation of PanOptix IOL during cataract surgery. Random-effects meta-analysis was performed to generate pooled proportions for patient-reported visual disturbances with a 95% confidence interval [CI]. Eleven unique studies were included, spanning 580 patients with bilateral implantation of PanOptix IOL from 10 countries with 1 to 12months follow-up. In summary, 33.6% of patients with bilateral PanOptix implantation experienced glare, 43.9% experienced halos, and 30.4% experienced starbursts. Among these patients, small percentages reported severe glare (2.9%), severe halos (5.4%), and severe starbursts (3.4%). Only 0.8%, 1.4%, and 2.6% of patients found glare, halos, and starbursts, respectively, to be very bothersome. Halos are the most frequently reported visual disturbances. However, the likelihood of experiencing severe and/or very bothersome visual disturbances (halos, glare, starbursts) is approximately 5% and 3%, respectively, after bilateral implantation of PanOptix IOL. These findings should inform clinical decision-making and treatment choices when selecting the most appropriate IOL implant for cataract surgery.

SMILE for correction of myopia in patients during the incipient phase of presbyopia.

To evaluate clinical outcomes and visual quality 12months after small incision lenticule extraction (SMILE) for correction of myopia with or without astigmatism in patients during the incipient phase of presbyopia. Peking University Third Hospital, Beijing, China. Retrospective observation study. Patients who had SMILE for myopia and myopic astigmatism with binocular plano target refraction and aged between 39 and 45years were included. Subjective refraction; distance, intermediate, and near visual acuities; defocus curve; anterior corneal surface aberrations and the Strehl ratio; accommodation function, and a subjective questionnaire assessing visual quality in real-life situations were evaluated 12months postoperatively. Clinical data of 29 cases were analyzed. The average patient age was 40.10 ± 0.94years. The mean preoperative manifest refraction was - 4.73 ± 1.11 D (range: - 2.13 to - 6.13 D) of spherical equivalent in right eyes. At the 12-month follow-up, binocular uncorrected distance visual acuity and uncorrected intermediate visual acuity ≥ 20/20 were achieved in all patients, and 96.6% (28/29) of patients achieved uncorrected near visual acuity ≥ 20/25. SMILE induced a statistically significant increase in spherical aberration, coma, and total higher-order aberrations (P < 0.001). For accommodative function, only the negative relative accommodation improved significantly after surgery (P < 0.001). The questionnaire demonstrated high patient satisfaction with near vision, and no one reported having severe visual disturbance. SMILE appeared to be safe and effective in improving distance vision in patients during the incipient phase of presbyopia, and a satisfactory amount of near vision was maintained in this group of subjects.

The effect of water consumption on the aqueous layer of the tear film

Background: Tear deficient dry eye is a condition of insufficient tear production and may cause discomfort and visual disturbances, and if untreated, may cause ocular surface damage. While various treatment options have been explored and are available, these are usually costly and invasive.Aim: This study aimed to investigate the effect of water consumption on the aqueous layer of the tear film.Setting: University of KwaZulu-Natal Eye Clinic.Methods: A quantitative experimental design was implemented on 85 healthy participants of both genders aged between 18 and 34 years old. Pre-screening procedures, followed by baseline Schirmer 1 readings were obtained on all participants. The participants thereafter consumed water in relation to their body mass. Schirmer 1 test was re-administered at time intervals of 15, 30, 45 and 60 min after water consumption.Results: The mean baseline Schirmer 1 result prior to water consumption was 9.95 mm ± 4.52 mm. The mean Schirmer 1 results, at 15, 30, 45 and 60 min, following water consumption were 14.56 ± 5.82, 16.82 ± 5.44, 13.49 ± 4.82 and 11.54 mm ± 4.22 mm, respectively with a P-value of 0.000.Conclusion: This study showed that water consumption has a statistically significant increase on the aqueous tear volume.Contribution: Water consumption has been shown to increase aqueous tear production and may serve as a more affordable option to reduce dry eye symptoms.

Immunotherapy-Related Hypophysitis: A Narrative Review

Immune checkpoint inhibitors (ICIs) have revolutionized oncology, providing a groundbreaking therapeutic option for patients with various advanced-stage cancers. While these treatments can significantly extend survival, they also carry a substantial risk of immune-related adverse events, among which hypophysitis is particularly detrimental to endocrine function. This narrative review synthesizes current knowledge on the pathogenesis, clinical features, diagnosis, and management of ICI-induced hypophysitis (IH) based on an in-depth analysis of the recent literature and clinical trials. The diagnosis of IH presents unique challenges due to its overlap with systemic symptoms commonly associated with the underlying malignancy. These symptoms can include asthenia, anorexia, headache, vomiting, weight loss, hypotension, dizziness, decreased libido, and visual disturbances. Diagnostic evaluation typically combines clinical assessment, hormonal profiling, and findings from magnetic resonance imaging (MRI). Effective management of IH requires a personalized, multidisciplinary approach, focusing on hormone replacement therapy and vigilant monitoring. Long-term care depends on the severity of hypophysitis, and the specific hormonal axes involved. This review aims to enhance awareness of the critical aspects of recognizing and managing IH, underscoring the importance of early diagnosis and timely intervention to reduce its long-term effects on patient quality of life.

P-51 A RARE CASE IN WHICH ACROMEGALY IS PROVEN CLINICALLY AND BIOCHEMICALLY DESPITE NEGATIVE GH IMMUNOHISTOCHEMICAL STAINING

Abstract Introduction The diagnosis of acromegaly is confirmed by high IGF-1 and GH levels. When a GH-secreting pitNET is resected, immunocytochemistry with GH staining typically supports the diagnosis. It is very rare for these tumors to stain negatively for GH in the presence of clinical and biochemical acromegaly. We are presenting a case of growth hormone (GH)-secreting PitNET with negative immunostaining for GH. Clinical Case 50-year-old male with history of headache and visual disturbances was found to have a pituitary macroadenoma. Years before the presentation, he noticed his shoe size had increased. Physical exam was notable for enlarged nose, thick lips, mandibular prognathism, and enlarged hands and feet. Blood pressure was 140/90 mmHg. Pre-operative laboratory results were remarkable for elevated GH 5.6 ng/ml (0.03-2.47) and IGF-1 816 ng/ml (80.6-207) levels. OGTT suppressed GH nadir 3.95 ng/ml. Pituitary MRI revealed an invasive macroadenoma measuring 37x31x40 mm (Figure 1). The patient underwent transsphenoidal surgery. Although GH and IGF-1 levels decreased after surgery, they did not return to the normal range. Visual field loss improved. Surprisingly, in the histopathological examination, no immunohistochemical staining was detected with GH and other anterior pituitary hormones, and Ki-67 was found to be 2%. Due to disease activity (IGF-1:278 ng/ml; 1.3XULN), medical treatment was started first with dopamine agonist and then continued with somatostatin receptor agonist (IGF-1:322 (1.6xULN). The remaining tumor tissue remained stable under treatment. Conclusion Silent somatotrophinomas detected by immunohistochemical staining have been reported in the literature. Conversely, endocrinologists should keep in mind that there may be rare cases in which immunohistochemical GH staining is negative but clinical and hormonal acromegaly is evidenced.Figure 1Magnetic resonance imaging (MRI) revealed a pituitary macroadenoma 37x31x40 mm in size, with Knosp grade 4 on the right and grade 1 on the left

Low Occurrence of Ocular Adverse Events after CAR-T Cell Therapy: A National Cohort Study

Introduction: Chimeric antigen receptor (CAR) T cell therapies have demonstrated remarkable therapeutic efficacy in leukemias and lymphomas that were previously considered incurable. However, concerns persist over potential risks related to toxicities, including those secondary to activation of the patient’s immune system. Methods: To investigate ocular adverse effects associated with CAR-T cell therapy, a retrospective cohort study was designed in which data were obtained from the TriNetX aggregated electronic health records database through August 2024, with data analysis performed in August 2024. Billing codes were used to identify patients receiving autologous CAR-T therapy approved by the US Food and Drug Administration (FDA) for the treatment of a hematological malignancy: tisagenlecleucel, brexucabtagene autoleucel, lisocabtagene maraleucel, ciltacabtagene autoleucel, idecabtagene vicleucel, or axicabtagene ciloleucel. Results: In a cohort of 684 patients on CAR-T therapy with at least 6 months of follow up, the most prevalent ocular adverse effects were related to vision changes (1.9%), which included vitreous opacities, visual disturbances, diplopia, and visual discomfort; inflammation (1.8%), which included optic neuritis, conjunctivitis, optic papillitis, chorioretinal inflammation, iridocyclitis, zoster ocular disease; and dry eyes (1.6%), which included dry eye syndrome, keratitis, and ocular manifestations of Vitamin A deficiency. Conclusion: In the period of 6 months following CAR-T therapy infusion, ocular adverse effects were rare in patients receiving CAR-T cell therapy, indicating that patients without existing eye conditions do not need routine pre-screening or directed follow up after treatment, unless symptomatic. Ongoing monitoring and reporting of ocular adverse events will be important given the durable effects of CAR-T therapy in the treatment of hematologic cancers as well as increasing indications for CAR-T therapy in malignant and non-malignant disease.

Dry eyes

Dry eye disease (DED), also known as dry eye syndrome (DES) or keratoconjunctivitis sicca (KCS) is one of the most common problems affecting the general population. It is a self-perpetuating cycle of inflammation and damage to the ocular surface. DES affects 15–33% of those aged over 65 years and prevalence increases with age. It is 50% more common in women than in men. There are many other risk factors for dry eyes. It is characterised by ocular irritation and visual disturbance. Dry eye can be classified into two main types. Hypo secretive (aqueous-deficient or tear deficient) causes and evaporative causes. Current treatment is heavily weighted toward supplementation, stimulation, preservation of aqueous tears or treatment of ocular surface inflammation. DED involves multiple deficiency states and can result in treatment failure and frustration. Furthermore, long-term use of some medication can cause harm to the ocular surface. It is estimated that the NHS spends annually over £27,000,000 pounds on over 6,400,000 prescriptions for artificial tears, ocular lubricants and astringents (figures from 2014). Over the last decade, considerable research has been carried out on the pathophysiological mechanisms involved. This article will explore the different ways in which DES presents and how to diagnose it as well as the main management options.

Spontaneous liver rupture associated with HELLP syndrome

Background: Spontaneous hepatic rupture is a rare life-threatening event seen among patients with preeclampsia and HELLP syndrome bringing devastating outcomes to both the mother and the baby.Case presentation: We report a case of a 45-year-old sub fertile primigravida following an IVF treatment with donor embryo resulting in DCDA twin pregnancy.She was diagnosed with pregnancy induced hypertension at 20 weeks of period of gestation (POG) with DCDA twin pregnancy admitted at our hospital at 32 + 4 weeks of POG with headache, visual disturbances, vomiting and abdominal pain with severe pregnancy induced hypertension. Category I emergency cesarean section was performed due to eclampsia, suspected placental abruption with DCDA twins with single fetal demise and acute kidney injury. During caesarean section, right lobe of the liver rupture was diagnosed. Even with intense multidisciplinary management the life of this mother could not be saved leaving behind her newborn baby with the father.Conclusion: Due to the rarity of the entity, the unpredictable nature and the multisystemic involvement, many health care providers as well as pregnant women may not be aware of the fatal consequences of this complication.

Intra-infundibular Epidermoid Cysts- A Distinct and Rare Entity.

Epidermoid cyst (EC) located completely within the pituitary infundibulum is a rare entity with only seven reported cases. In this study, we have described our experience with resection of intra-infundibular epidermoid cysts (IECs) and reviewed the existing literature highlighting its distinguishing features and operative nuances. Three consecutive cases of IEC operated at our institute was retrospectively studied. PubMed and EMBASE databases were searched, and seven case reports of IEC were found. Relevant clinical, radiological, operative data of ten cases were analyzed. The median age at diagnosis was 53.5 years and six cases were males. Preoperatively, although the average tumor size was only 1.62 cm3, 80% of patients had visual disturbance, and 78% of patients had deficiency in pituitary hormones. Five patients had preoperative diabetes insipidus. Mild diffusion restriction was noted in four out of five cases that mentioned it. The most common differential diagnosis considered was Rathke's cleft cyst and craniopharyngioma. Adhesion of the cyst wall to the stalk and/or the hypothalamus was a common occurrence resulting in residual wall being left behind in 50% cases. Expanded endoscopic endonasal approach was utilized in nine cases and one case underwent fronto-temporal craniotomy with resection via pretemporal approach. Postoperative chemical meningitis was demonstrated in two cases and sterile abscess was noted in another case. IECs are rare tumors that are often misdiagnosed preoperatively. They have different postoperative morbidity profiles compared to other cystic lesions in the infundibulum. This makes it important to recognize this distinct entity.

Outcomes of a non-diffractive extended depth of focus intraocular lens in patients with well-controlled glaucoma and ocular hypertension.

To assess visual outcomes and satisfaction of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in individuals with ocular hypertension (OHT) and well-controlled mild glaucoma undergoing cataract surgery. An investigator-initiated, single-center, prospective, interventional, noncomparative study conducted in Montreal, Canada. The study enrolled 31 patients (55 eyes) with OHT or mild glaucoma who received a non-diffractive EDOF IOL (Acrysof IQ Vivity). Participants underwent sequential cataract surgery with the Vivity IOL. Follow-up evaluations occurred at 1d, 1, and 3mo postoperatively, assessing uncorrected distance, intermediate, and near visual acuity. Questionnaires (QUVID: Questionnaire for visual disturbances and IOLSAT: Intraocular lens satisfaction) were administered pre and post-operatively to measure visual disturbances and spectacle independence in various lighting. Safety parameters included intraocular pressure (IOP), glaucoma medications, spherical equivalence, mean deviation and pattern standard deviation or square root of lost variance on Octopus visual field. At 1 and 3mo postoperatively, significant improvements were observed in uncorrected distance and intermediate visual acuity. Spectacle independence was enhanced for distance and intermediate vision, especially in bright light settings. Spectacle-free intermediate vision was improved even in dim lighting. Visual disturbances, particularly glare symptoms, were reduced, and there was a notable decrease in IOP and glaucoma medication burden at 3mo. There was more hazy vision postoperatively with no impact on visual acuity and visual satisfaction. The non-diffractive EDOF lens improves distance and intermediate spectacle-free visual function in patients with OHT and well-controlled glaucoma. The findings highlight significant improvements in visual acuity, reduced glare, enhanced spectacle independence, and improved visual performance in different lighting conditions.

Perceptual Disturbances and Disorders in the ICD-11: An Overview and a Proposal for Systematic Classification.

The International Classification of Diseases (ICD) has been developed and edited by the World Health Organisation and represents the global standard for recording health information and causes of death. The ICD-11 is the eleventh revision and came into effect on 1 January 2022. Perceptual disturbances refer to abnormalities in the way sensory information is interpreted by the brain, leading to distortions in the perception of reality. These can manifest as distorted perceptions or as phantom perceptions and can occur in all sensory modalities as visual, auditory, olfactory, gustatory tactile, vestibular, proprioceptory or interoceptory disturbances. There are similar brain mechanisms involved in the generation of these analogous perceptual disturbances and disorders, and they are treated with similar approaches. Perceptual disturbances are highly prevalent, with large variations across the different sensory modalities. They can be associated with significant suffering and cause a high socioeconomic burden. Perceptual disturbances can be symptoms of another disease or disease entities on their own. In the context of pain, this is reflected by the distinction between secondary pain (pain as a symptom of another underlying condition) and primary pain (a disease in its own right, rather than being a symptom of another underlying condition) in the ICD-11. Such a clear distinction is not found in an entirely consistent way across the various sensory modalities. By using the example of auditory phantom perceptions, we propose a framework for the classification of sensory disorders in alignment with the classification of pain in the ICD-11. The descriptions of the sensory disturbances should include (1) a causal aspect (primary versus secondary), (2) a temporal aspect (acute vs. chronic and persistent vs. intermittent), (3) a cognitive, emotional and autonomic interpretation aspect (=suffering) and (4) a social aspect (=disability). If the latter two aspects are present, we propose that the sensory disturbance is called a sensory disorder.

Superior hypophyseal artery aneurysm: microsurgical vs. endovascular treatment.

This study aimed to provide an updated evidence of superior hypophyseal artery (SHA) aneurysms management, including their clinical implications, predictive factors for rupture, therapeutic approaches, and post-treatment outcomes. This systematic review and meta-analysis, following PRISMA guidelines, assessed the literature on superior hypophyseal artery aneurysms. Studies were selected based on predefined criteria, focusing on coiling and clipping interventions. Data were extracted and analyzed using SPSS and Cochrane RevMan, with assessments of heterogeneity, sensitivity, and publication bias. Study quality was evaluated using the Newcastle-Ottawa Scale and RoB2. A total of 20 studies involving 316 patients were included. The clipping group had a mean age of 53.8 years, while the coiling group had 50.3 years. Most aneurysms were smaller than 7mm. Aneurysm remnants occurred in 1.1% after clipping and 2.8% after coiling. Clipping was associated with lower recurrence rates (0% vs. 9.3%) and fewer visual disturbances and vasospasms. Mortality was equal (1%) for both groups. The coiling group had better outcomes on the modified Rankin Scale (94% vs. 73% for clipping). Meta-analysis confirmed that clipping had better recurrence and functional outcomes, with no significant differences in aneurysm size or mortality. Surgical clipping is a viable treatment for SHA aneurysms but carries risks, while coil embolization offers a safer, effective alternative. Early intervention, especially for larger aneurysms (> 7mm), is crucial to prevent rupture. Future research should focus on personalized treatment strategies, as this study's small sample size and study limitations warrant further investigation.

Posterior Reversible Leukoencephalopathy Syndrome During Hypertensive Crisis in Obstructive Sleep Apnea Syndrome: Searching for a Link.

Posterior reversible encephalopathy syndrome (PRES) may present with different clinical symptoms including visual disturbance, headache, seizures and impaired consciousness. Brain MRI shows oedema, usually involving the posterior subcortical regions. Triggering factors include hypertension and obstructive sleep apnea syndrome. The mechanism underlying PRES is under debate, but endothelial dysfunction is implicated. Treatment goals of PRES are gradual blood pressure (BP) lowering to avoid sudden hypoperfusion of vital organs and prevention and management of seizures. PRES usually has a favorable prognosis, but delayed diagnosis and treatment may lead to cardiovascular morbidity, mortality or irreversible neurological deficits.

Resection of Meningiomas Invading the Cavernous Sinus: Treatment Strategy and Clinical Outcomes.

Background/Objectives: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes. Methods: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated. Results: The mean patient age was 59.1 years (range, 23-73 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1. Conclusions: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor.

Efficacy of light-transmitting eye shields for wound dressing in preventing pediatric emergence agitation following bilateral strabismus surgeries: a randomized clinical trial.

Emergence agitation (EA) occurs in preschool children after ophthalmic surgery as eye shields induce visual disturbance. We aimed to investigate the efficacy of light-transmitting eye shields as an alternative to traditional medical gauze eye shields for wound dressing in terms of EA incidence following strabismus surgery. We randomly assigned 70 preschool children undergoing bilateral strabismus surgery to receive either light-transmitting (LT group, n = 35) or medical gauze (MG group, n = 35) eye shields upon the completion of surgery. The primary outcome was the difference in EA incidence between the groups. After adjusting the data for age and sex, children in the LT group were less likely to develop EA than those in the MG group (5 of 35 children [14.3%] vs 15 of 35 children [42.9%]; adjusted odds ratio [OR], 95% CI: 0.28, 0.08-0.94; P = 0.040). Compared with the MG group, a significant reduction in the median score of the peak Aono's four-point scale was observed in the LT group (P = 0.024; Benjamini-Hochberg [BH] critical value = 0.050). Additionally, the incidences of agitation (peak Pediatric Anesthesia Emergence Delirium score ≥ 16) and propofol administration in the LT group were significantly lower than those in the MG group (P = 0.022; BH critical value = 0.038 and P = 0.017; B-H critical value = 0.025, respectively). The application of light-transmitting eye shields for wound dressing could help prevent EA after pediatric bilateral strabismus surgery under sevoflurane anesthesia.

Therapeutic benefits of glycerol in dry eye disease.

Dry eye disease (DED) is one of the most commonly diagnosed eye disorders, with a prevalence ranging from 5 to 50%, depending on the geographic location. DED is a multifactorial disorder of the tears and ocular surface, which results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is also accompanied by increased osmolarity of the tear film and inflammation of the surface of the eye. Multiple therapeutic agents have been used to treat DED, with glycerol emerging as a promising component of ophthalmic preparations, due to its humectant, lubricant, demulcent, and osmoprotective properties. This review aims to evaluate the current evidence concerning the therapeutic benefits of glycerol in managing DED, focusing on its possible mechanisms of action, clinical efficacy, and potential advantages over other treatments.

Midterm Outcomes of the Endoscopic Endonasal Approach for Treating Tuberculum Sellae Meningiomas: The Impact of Malleable Forceps and Predictors of Surgical Success

Abstract Objective To evaluate the midterm surgical outcomes and factors associated with the extent of resection (EOR), postoperative visual improvement, and risk factors for postoperative cerebrospinal fluid (CSF) leaks in cases of the endoscopic endonasal approach (EEA) for tuberculum sellae meningiomas (TSMs), including cases utilizing the malleable forceps. Design Retrospective clinical study. Setting Single-center tertiary referral hospital. Participants Twenty-two patients who underwent the EEA for TSMs between November 2013 and April 2024. Main Outcome Measures Patient characteristics, intraoperative findings, and postoperative outcomes were evaluated. Predictors of the EOR, postoperative visual improvement, and postoperative CSF leaks were investigated. Results The median age was 58 years, with 77.2% being women. The median follow-up was 70.5 months, and the mean tumor size was 23.5 mm. Gross total resection (GTR) was achieved in 18 patients (81.8%), with no recurrence. Adhesion to the optic nerve was significantly associated with the EOR (p = 0.001). The malleable forceps were used in 14 out of 22 cases, and the GTR rate increased to 92.8% (13 out of 14 cases) with this instrument._Postoperative visual improvement was achieved in 16 of 19 patients (84.2%) and was significantly associated with tumor size (p = 0.02) and the duration of preoperative visual disturbances (p = 0.002). Two patients (9.0%) experienced postoperative CSF leaks, significantly associated with sex (p = 0.04) and Simpson grade (p = 0.032). Conclusion The EEA yielded favorable outcomes and significant postoperative visual improvement for TSMs, supporting early intervention for symptomatic TSMs and radical treatment for GTR. The malleable forceps can enhance the management of complex procedures.

Posterior Reversible Encephalopathy Syndrome in a Young Sudanese Female

Posterior reversible encephalopathy syndrome (PRES) is a rare, reversible radio-neurological condition. It commonly presents with seizures, visual disturbances, headaches, impaired level of consciousness, and other focal neurological findings. PRES is often associated with high blood pressure and can result from various causes, including autoimmune disorders, certain medications, and eclampsia. Pathophysiologically, it is characterized by reversible vasogenic cerebral edema predominantly in the occipital and parietal lobes. We report a case of a young Sudanese female with systemic lupus erythematosus (SLE), presenting with generalized seizures and headache. These symptoms occurred without fever and were associated with high blood pressure. Neuro- radiological imaging findings, typical clinical presentation, and the reversibility of the condition confirmed the diagnosis of PRES. This is, to the best of our knowledge, the first case report of PRES in SLE patients from El Obeid, North Kordofan, Western Sudan.