Acuity Of Hand Motion Research Articles

Acute worsening of retinal lesions during oral steroid treatement in a case of intracular lymphoma

AbstractPurpose Diagnosis and treatment of intraocular lymphoma remains a clinical challenge. Herein, we present a complicated case in which the diagnosis was made after the acute worsening of retinal lesions during oral steroid treatement.Methods A 49 year old woman complaning of progessive visual acuity decrease was referred with visual acuity of hand movements in the right eye accompanied by vitritis and two peripheral white retinal lesions with vasculitis. Futher examinations excluded the diagnosis of the main causes of infectious and non infectious uveitis and pathological examination of vitreous cells was not compatible with the diagnosis of lymphoma.Results Systemic steroid treatment were given with an initial improvement of the inflammatory conditions. However, a week later an acute worsening of the retinal lesions occured, taking the appearence of a very severe retinal necrosis. Another vitrectomy was thus performed to exclude again infectious causes but was negative for virus and toxo. Finally, the diagnosis of intraocular lymphoma was made on a 3rd diagnostic vitrectomy with retinal biopsy. The patient was treated with a series of intravitreous methotrexate injections followed by chemo‐ and radiotherapy.Conclusion Systemic administration of corticosteroids in patient with intraocular B lymphoma may lead to dramatic lesion extention preceeded by temporal clinical stabilisation or improvement.

Central Retinal Vein Occlusion Treated with Ozurdex: A Case Report and Review of Literature

To describe the retinal changes occurring after Ozurdex(®) (Ozurdex, Allergan, Inc., Irvine, CA) injection and peripheral laser treatment in a case of central retinal vein occlusion (CRVO). A 51-year-old Caucasian man with massive retinal edema (926 μm) and hand motion visual acuity due to severe CRVO was treated early with Ozurdex intravitreal injection. Detailed monthly follow-up examinations showed complete resorption of the edema (253 μm) after 2 months and a 20/32 visual outcome after 3 months. The patient subsequently developed peripheral retinal ischemia accompanied by recurrence of small retinal cystoid spaces (295 μm); therefore, he underwent an associated laser treatment on the involved peripheral retina, which led to a recovery in retinal thickness (280 μm). His visual acuity remained stable at 20/32. Early Ozurdex injection in association with late laser photocoagulation was effective in the resorption of CRVO macular edema and in restoring reasonably good visual acuity.

Young Man With Fever and Eye Pain

A 21-year-old man presented with several days of fever, sinus pain, decreased vision, and pain with eye movement. Examination revealed proptosis and periorbital edema/erythema, with an afferent pupillary defect and a visual acuity of hand-motion in the right eye (Figure 1). A computed tomography (CT) scan showed opacification of the frontal, ethmoid, and maxillary sinuses bilaterally, with right-sided orbital inflammatory changes and a subperiosteal abscess in the superomedial orbit (Figure 2). The patient began receiving vancomycin, ceftazidime, and metronidazole.

Short-term visual outcomes of Boston keratoprosthesis type i in Saudi Arabia

Purpose:To evaluate the visual outcomes, complications and retention of threadless type I Boston keratoprosthesis (KPro) in Saudi Arabia.Materials and Methods:Retrospective analysis of four eyes of four patients (one female and three males; age range: 48 to 72 years) who underwent Boston type I threadless KPro implantation between January and December 2009.Results:In the median follow-up of 11 months (range 6 to 14 months), visual outcomes were satisfactory. Preoperative diagnosis included two patients of post-trachoma dense vascularized corneal scarring, one patient of corneal alkali burn and one patient of repeated failed corneal grafts. All patients demonstrated significant improvement in vision; with pre-operative visual acuity of hand movements (HM), counting fingers and HM improved to best corrected visual acuity (BCVA) of 20/200, 20/60, 20/50 and 20/30 on their last follow-up visits respectively. None of the patients developed glaucoma as a result of the procedure. No retro-prosthetic membrane developed till the last follow-up visit. One of the four patients had a corneal melt (due to severe dryness associated with trachoma) 6 months after the KPro implantation and underwent a successful KPro revision. Despite the relatively poor prognosis expected in alkali burn eye, the patient attained the maximum BCVA (20/30) of the four eye series on the last follow-up visit at six months.Conclusion:In consistent with the earlier reports from other parts of the world, all the 4 eyes had a significant increase in vision after Boston type I KPro implantation. However, patients require close lifelong follow-up to manage any complications.

Neuropathie optique rétrobulbaire et lymphome malin non hodgkinien

Non-Hodgkin lymphomas (NHLs) constitute a group of heterogeneous diseases that can arise in lymphatic nodal or extranodal sites. Ocular lymphomas account for 1% of all NHLs. Tumor of the orbit, which can lead to compression of the optic nerve, is the most frequent presentation of the disease. Primary infiltration of the optic nerve and its sheath remains exceptional.We report the case of a 51-year-old female patient treated for a NHL. While she was considered to be in remission after four courses of chemotherapy, she presented a right visual loss with hand motion acuity. Her examination revealed a right afferent pupillary defect. Brain MRI emphasized an infiltration of her right optic nerve with no other orbit abnormality. Cerebrospinal fluid analysis showed lymphomatous meningitis. She was then considered to have lymphomatous optic neuropathy (LON). Despite initial improvement of the visual acuity with treatment, the patient died of bone marrow aplasia 6 weeks later.LON can be suspected in a painful and sudden visual loss in a context of neoplasia. The diagnosis is confirmed by MRI and cerebrospinal fluid analysis. LON may occur as the sole ocular manifestation of disease recurrence in a patient with systemic NHL, otherwise thought to be in clinical remission.

Small‐gauge vitrectomy in traumatic retinal detachment

To report the outcome of retinal detachment surgery following trauma treated with small-gauge vitrectomy. Retrospective chart review. Adult patients presenting with a retinal detachment following severe trauma between 2007 and 2009 that underwent vitreoretinal surgery with either 25- or 23-gauge vitrectomy. Data collected included; age, sex, eye, time interval between injury and diagnosis of retinal detachment, anatomical and functional success, complications, and length of follow up. Anatomical and functional outcome. Nineteen consecutive adult patients with traumatic retinal detachment were included. The mean age was 51.4 ± 19.3 years; 68.5% were male. Thirteen patients (68.4%) presented with visual acuity of hand movement or worse including six patients with light perception only. Five eyes achieved 6/60 vision or better, and three eyes had visual acuity of 6/12 or better. During the period of follow up six eyes experienced a recurrent retinal detachment. Traumatic retinal detachment can be successful managed with small-gauge vitrectomy.

Safety of Vitrectomy for Floaters

To assess the risks of vitrectomy for the removal of primary and secondary vitreous opacities. Retrospective, nonrandomized, interventional case series. We reviewed the results of 116 consecutive cases of vitrectomy for vitreous floaters. Eighty-six cases were primary and 30 cases were secondary floaters. Main outcome measures were the incidence of iatrogenic retinal breaks and postoperative rhegmatogenous retinal detachments. We found iatrogenic retinal breaks in 16.4% of operations. There was no statistically significant difference in risk between cases of primary and secondary floaters. Intraoperative posterior vitreous detachment induction was found to increase significantly the risk of breaks. Retinal detachment occurred in 3 cases (2.5%), all after operations for primary floaters. One case of complicated retinal detachment ended with a low visual acuity of hand movements. Cataract occurred in 50% of phakic cases. Transient postoperative hypotony was found after 5.2% of our operations, and transient postoperative high intraocular pressure was encountered in 7.8%. An intraoperative choroidal hemorrhage occurred in 1 case, which resolved spontaneously. The mean visual acuity improved from 0.20 to 0.13 logarithm of the minimal angle of resolution units. The risk profile of vitrectomy for floaters is comparable with that of vitrectomy for other elective indications. Retinal breaks are a common finding during surgery and treatment of these breaks is crucial for the prevention of postoperative retinal detachment. Patients considering surgery for floaters should be informed specifically about the risks involved.

Bilateral Irreversible Severe Vision Loss From Cosmetic Iris Implants

To report a case of bilateral neovascular glaucoma with central retinal vein occlusions secondary to cosmetic iris implantation. Interventional case report. setting: Tertiary care center; ophthalmology clinic. patient: A 25-year-old woman presented with persistent bilateral blurry vision after simultaneous bilateral cosmetic iris implantation. Examination showed best-corrected visual acuity of hand motion in the right and 20/400 in the left eye with intraocular pressures (IOP) of 48 mm Hg in the right and 40 mm Hg in the left eye on maximal medical therapy. She had bilateral neovascularization of the iris and angle with synechial angle closure, surgical aniridia, central retinal vein occlusion, and end-stage glaucomatous optic neuropathy. She was diagnosed with neovascular glaucoma in both eyes, associated with cosmetic iris implants. intervention procedures: Humphrey 24-2 visual field testing, optic nerve coherence tomography, and fundus imaging were performed. After bilateral intravitreal bevacizumab and panretinal photocoagulation, Ahmed glaucoma drainage devices were implanted in both eyes. main outcome measures: IOP, anterior chamber inflammation, neovascularization. Despite aggressive treatment, severe permanent bilateral vision loss ensued. We strongly advise against the use of anterior chamber iris implants for cosmetic indications. Close monitoring of implanted individuals is necessary. Explantation should be considered at the earliest sign of adverse reaction.

Prognostic Factors After Repair of Open Globe Injuries

Background: To identify prognostic factors for visual acuity and anatomic outcomes after repair of open globe injuries. Methods: We retrospectively reviewed the medical records of 443 patients with open globe injuries admitted to King Abdulaziz University Hospital between May 1996 and January 2008. Results: Predictors of good visual outcome (20/200 or better) were age of 18 years or younger, good initial visual acuity of counting fingers or better, sharp mechanism of injury, wound length of 10 mm or less, wounds limited to the cornea, absence of associated ocular injuries at presentation including lens injury, vitreous hemorrhage, vitreous prolapse and retinal detachment, absence of endophthalmitis, vitrectomy not performed, and findings at final evaluation including clear vitreous, attached retina, and absence of hypotony. Predictors of persistent retinal detachment at final evaluation were poor initial visual acuity of hand motions or worse, posterior wound location, and performance of vitrectomy. Predictors of hypotony at final evaluation were poor initial visual acuity of hand motions or worse, dirty wound, presence of vitreous hemorrhage, and vitreous prolapse at presentation, development of culture-positive endophthalmitis, performance of vitrectomy, and persistent retinal detachment at final follow-up. Conclusions: Prognosis after repair of an open globe injury is influenced by age, initial visual acuity, mechanism of injury, location and extent of initial damage, and development of endophthalmitis.

Longterm follow‐up of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma

This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLCP) in advanced refractory glaucoma. A total of 124 eyes in 121 patients with advanced glaucoma refractory to medical treatment were treated consecutively with TDLCP. Success was defined as final intraocular pressure (IOP) of 5-21 mmHg in eyes with visual acuity (VA) of more than hand movements (HM) and relief of pain in eyes with VA of HM or less, including blind eyes. Mean patient age was 65.6 +/- 17.1 years (range 14-91 years). Mean follow-up was 17 +/- 14.6 months (range 3-42 months). Mean pretreatment IOP was 29.9 +/- 8.4 mmHg (range 17-58 mmHg) and IOP at last follow-up was 20.8 +/- 8 mmHg (range 6-45 mmHg) (p < 0.001). The number of laser applications (mean 9.2 +/- 2.8, range 4-15) and maximal laser power (mean 2.01 +/- 0.22 mW, range 1.3-3.0 mW) were not associated with lower postoperative IOP. Intraocular pressure of < or = 21 mmHg was recorded in 63.0% of eyes at the last follow-up visit. Overall, 28 (21.7%) eyes required at least one retreatment. No phthisis bulbi or persistent hypotonia developed. TDLCP is an effective and safe method for the treatment of advanced refractory glaucoma, although repeated treatments are often necessary.

Acute retinal necrosis.

Purpose: Clinical features in a case of acute retinal necrosis are described as well as its diagnostic approach and response to early treatment. Methods: This is a descriptive and retrospective study case report of a 26 year old male patient who arrived to the emergency room with a three day history of sudden visual loss in the right eye (RE). At initial evaluation a visual acuity of hand movements in the RE, 20/15 in the left eye (LE) and a right relative afferent pupillary defect were found. Fundoscopy revealed profuse soft exudates and hemorrhages involving posterior pole, inferior hemiretina and superotemporal periphery. Infectious workup and fluoresceinic angiography were made and positive serologies for herpes virus types 1 and 2, without HIV, were found. A diagnosis of acute retinal necrosis was made and treatment with intravenous valgancyclovir for two weeks and intra-vitreous triamcinolone for severe vasculitis, was given. Then a 3 months treatment with oral antiviral agents was prescribed. Results: Patient’s evolution showed improvement with treatment and at two and a half months of follow up, visual acuity was 20/50 in the right eye, normal slit lamp examination, tonometry of 12 mm Hg and fundoscopy improved when compared to initial pictures.Conclusions: A high index of suspicion is needed for diagnosing ARN taking into account clinical findings. Prompt intravenous and intra-vitreous treatments are needed to achieve good clinical and functional outcomes and to avoid central nervous system complications.

Ocular Nail Gun Injuries: Epidemiology and Visual Outcomes

Nail-gun accidents have become a common reason for penetrating ocular injuries in patients presenting to the emergency room with globe trauma. To date, there are only five patients (one case report and one small case series) in the medical literature of penetrating ocular injury due to nail-guns. The aim of this study is to describe the epidemiology and visual outcomes of patients presenting to a tertiary medical center with ocular injuries resulting from nail-gun injuries. This is an institutional review board-approved retrospective chart review of 24 patients presenting to the Medical University of South Carolina after sustaining eye injuries secondary to the use of nail-guns. The records of 178 patients with penetrating eye injuries treated between July 1996 and June 2006 were reviewed. Twenty-four patients (14%) had open globe injuries related to nail-guns. Demographic data, ocular examination findings, and visual outcomes were recorded. Of the 24 cases identified, 17 were work-related; this represented approximately 71% of patients. All were men with an average age of 29.4 years. Fifty-eight percent of the patients were non-English speaking. There was no record of any patient wearing safety glasses at the time of injury. The visual acuity at presentation ranged from 20/20 to hand motion or worse. Half (50%) of these patients had a presenting visual acuity of hand motion or worse. At last examination, 38% (nine patients) had visual acuity of 20/40 or better, 34% (eight patients) had visual acuity of counting fingers to hand motion, 13% (three patients) 20/60, 4% (one patient) 20/200, and three were lost to follow-up. The correlation coefficient between visual acuity at presentation and most recent was significant at 0.679 (p = 0.001). The majority of nail-gun injuries presented in this series were work-related. These injuries could be prevented with adherence to established safety measures including proper training and education of nail-gun operators, the use of sequential-trip triggers, and required safety glasses. Visual acuity outcomes of these 24 patients are better than what might be expected due to the nature of the injury.

Validation of Modified Grating Test as a visual acuity test in low vision patients with retinitis pigmentosa

Abstract Purpose The Modified Grating Test is a newly designed test for visual acuity (VA) measurement in patients with retinitis pigmentosa (RP) with low vision. Freiburg Visual Acuity Test (FrACT) is a validated test for low vision, but no patients with RP were tested. In our study we tested RP patients investigating the consistency of the Modified Grating Test by comparing the results with those of the FrACT and the ETDRS charts. Methods 16 eyes of 8 patients were tested and divided into 3 groups depending on their VA. Group 1 had a VA of hand motion (HM, n= 6), group 2 counting fingers (CF, n=6) and group 3 better than CF (n=4). The Modified Grating Test consists of a circle with black and white bars of the same width in a decreasing logarithmic order covering the range from 2.7 to 0.3 logMAR. The FrACT is a computerized test with Landoldt C in different directions and in decreasing order. ETDRS charts were used at a distance of 0.5m. Each test was performed 4‐5 times. The data were normally distributed. To compare the values we used the paired samples t‐test. Results The mean VA in group 1 as measured by the Modified Grating Test was 1.3 logMAR and by FrACT 1.21 logMAR (p=0.21). In the group 2 the patients reached a mean VA of 0.7 logMAR with the Modified Grating Test and 0.6 logMAR with FrACT. 0.68 logMAR was measured with ETDRS charts (p=0.13). Conclusion Our preliminary data suggest that the Modified Grating Test is a suitable test for the low vision range and might be beneficial for the follow up in patients undergoing a retinal prosthesis implantation.

Successful Salvage Treatment of Scedosporium apiospermum Keratitis with Topical Voriconazole After Failure of Natamycin

To report successful management of Scedosporium apiospermum (previously known as Monosporium apiospermum) keratitis with topical voriconazole as monotherapy. A 54-year-old previously well woman presented to the emergency department with a painful, injected right eye. There was no history of trauma or use of contact lenses. On examination, the right eye was estimated to have visual acuity of hand movement. Slit lamp examination detected a 2.5 x 3.5 mm dense, central corneal infiltrate with overlying epithelial defect. The eye had mild corneal edema with anterior chamber inflammation. Microbiology testing revealed S. apiospermum as the primary pathogen. Hourly administration of topical natamycin 5% resulted in initial improvement in visual acuity to 20/50, with reduction in the size of the central infiltrate. However, 1 month later, the eye infection relapsed, with recurrence of epithelial defect (3.1 x 3.1 mm) and decline in visual acuity to 20/100. Antifungal therapy was switched to topical voriconazole 1%, administered every 2 hours. Vision improved to 20/30 within 5 days, and the central defect had completely re-epithelialized within 1 week. Treatment of S. apiospermum keratitis remains inadequate. A high natamycin minimum inhibitory concentration is necessary to treat S. apiospermum infection, which may explain the persistence of central infiltration despite ongoing therapy. The combined use of topical and oral voriconazole for the treatment of S. apiospermum keratitis has been reported. However, this is the first report of a successful clinical experience using topical voriconazole without oral therapy to manage S. apiospermum keratitis. This eliminates some disadvantages associated with oral voriconazole such as high cost, potential significant toxicity, and drug interactions. The voriconazole 1% eye drop used alone is a promising, cost-effective, safe option for managing fungal keratitis, even that caused by S. apiospermum. It may have a larger role to play than simply that of adjunctive therapy.

ACUTE-ONSET ENDOPHTHALMITIS AFTER CATARACT SURGERY

To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

A Comparative Study Between Diode Laser Cyclophotocoagulation and the Ahmed Glaucoma Valve Implant in Neovascular Glaucoma

To compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. A total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. Mean age of the patients was 60.0+/-11.7 years (range: 20 to 85) in the DCPC group and 57.2+/-10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4+/-11.9 mm Hg and 43.3+/-7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5+/-11.3 mm Hg and 22.09+/-7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. There was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

Transscleral sulcus fixation of a small-diameter iris-diaphragm intraocular lens in combined penetrating keratoplasty and cataract extraction for correction of traumatic cataract, aniridia, and corneal scarring

We present the case of a 36-year-old Hispanic man who presented with photophobia and hand motion acuity from a lacerated cornea. Primary repair had been performed 13 years earlier. In addition to a densely scarred cornea and a fibrotic, partially resorbed cataract, more than 300 degrees of iris loss was noted. The patient was treated with penetrating keratoplasty, cataract extraction, and implantation of a transsclerally fixated, small-diameter aniridic intraocular lens (IOL). Despite the significant iris loss, a small-diameter IOL was chosen over a standard larger aniridic IOL to allow safer, more controlled insertion through an 8.0 mm trephination. Following surgery, the visual acuity improved to 20/25 with no symptoms of glare or photophobia.

Long-term Visual Prognosis in Children after Corneal Transplant Surgery for Peters Anomaly Type I

To evaluate the long-term visual prognosis in children with corneal transplant surgery for Peters anomaly type I. Retrospective review of interventional case series. Twenty-four children treated in a university-based practice were divided into two groups for analysis: a younger preverbal group and an older group of children three years of age or older. Children underwent corneal transplantation surgery (penetrating keratoplasty [PKP]) for Peters anomaly type I as infants (age range, two to 18 months). Visual acuity using Snellen or Allen charts and glaucoma and other complications were tabulated. Twenty-four patients had Peters anomaly; 16 had unilateral disease, eight had bilateral disease. Thirty eyes underwent PKP. Average age at PKP was five months. The mean follow-up from PKP to the most recent visit was 78.9 months. Fifteen eyes (50%) were treated for glaucoma. Five transplants (17%) had graft rejection episodes; two of these failed and were regrafted. Six eyes (20%) required cataract surgery. One eye had a retinal detachment. Currently, 27 eyes (90%) have clear grafts. In the younger group of children, five of six grafts are clear (83%). In the older group of 24 eyes of verbal children, seven eyes (29%) have visual acuity ranging from 20/20 to 20/50, six (25%) have visual acuity ranging from 20/60 to 20/100, nine (38%) have visual acuity ranging from 20/200 to counting fingers, and two eyes (8%) have visual acuity of hand movements. In this group, nine of 12 eyes without glaucoma had visual acuity better than 20/100; only four of 11 eyes with glaucoma were better than 20/100. Many children with PKP for Peters anomaly type I can experience good or functional vision in their operated eye. Children with glaucoma have a poorer visual prognosis.

Postoperative infectious endophthalmitis after triamcinolone-assisted anterior vitrectomy

Extracapsular cataract extraction and intraocular lens (IOL) implantation was performed in the left eye of a 64-year-old woman. Preoperative assessment showed a hypermature cataract in the left eye with visual acuity of hand movement. During IOL implantation, a posterior capsule rupture occurred in the inferior area. Triamcinolone was injected into the anterior chamber to visualize the vitreous and helped in thorough removal of the prolapsed vitreous. However, when postoperative infectious endophthalmitis developed, the signs and symptoms were vague. Careful examination, specific patient instructions, and close follow-up are necessary after a triamcinolone-assisted anterior vitrectomy.

58-Year-Old Man With Fever and Right Eye Pain

58-Year-Old Man With Fever and Right Eye Pain