Visual Field Changes Research Articles

Visual Field Changes in Normal Tension Glaucoma (NTG)

Aim: To observe the visual field changes in normal tension glaucoma Study design: Cross sectional study Study site: Department of Physiology, Khyber Medical College, Peshawar Study period: six months Sample size: 100 cases were included who fulfil the criteria. Results: There were 33(33%) males and 67(67%) females in the study. Visual fields of eyes were investigated. It was revealed that in cases with the right eye problem, 67(67%) had paracentral scotoma, 27(27%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 5(5%) had arcuate scotoma, while in the left eye cases, 67(67%) had paracentral scotoma, 30 (30%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 2(2%) had arcuate scotoma. Conclusion: Visual fields of eyes revealed that in cases with the right eye problem, 67(67%) had paracentral scotoma, 27(27%) had superior & inferior nasal steps, 1(1%) had scotoma closer to fixation and 5(5%) had arcuate scotoma, while in the left eye cases, 67(67%) had paracentral scotoma, 30(30%) had superior & inferior nasal steps, 1 (1%) had scotoma closer to fixation and 2(2%) had arcuate scotoma. Keywords: Visual field, open angle glaucoma, normal tension glaucoma

Characteristics of Optic Disc and Visual Field Changes in Patients with Thyroid-Associated Orbitopathy and Open-Angle Glaucoma.

This study aimed to characterize the changes in the visual field (VF) patterns and disc morphology of patients with thyroid-associated orbitopathy (TAO) and open-angle glaucoma (OAG). A retrospective review of the medical records at the Tri-Service General Hospital in Taiwan identified 396 eyes of 198 patients with thyroid-associated glaucoma. A final follow-up of VF examination in 140 eyes revealed 114 eyes with VF defects, indicating disease progression. The characteristics of and changes in disc morphology, optical coherence tomography findings, and VF defects were statistically analyzed. The most common VF defects at the initial diagnosis and the end of the follow-up period were inferior partial arcuate (17%) and paracentral (15%) defects, respectively. The most common VF defect in patients with unspecific disc signs was an unspecific scotoma (13%). The most common optic disc feature was disc cupping (51%), followed by parapapillary atrophy (48%). The most frequent location of nerve fiber layer thinning was the inferotemporal region (48%). VF defects showed a significantly more pronounced progression in the non-nerve fiber bundle group than in the nerve fiber bundle group (p < 0.001). This study details the characteristics and progression of disc morphology and VF defects in patients with TAO and OAG.

Segmented retinal analysis in pituitary adenoma with chiasmal compression: A prospective comparative study.

Purpose:The aim of this study was to determine the alteration in ganglion cell complex and its relationship with retinal nerve fiber layer (RNFL) thickness as measured by spectral-domain optical coherence tomography (OCT) in pituitary adenoma cases and also its correlation with visual field (VF).Methods:This is a prospective comparative study wherein detailed neuro-ophthalmic examination including perimetry, RNFL and ganglion cell layer inner plexiform layer (GCL-IPL) thickness were measured preoperatively in the cases of pituitary adenoma with chiasmal compression with visual symptoms and field changes who were planned for neuro-surgical intervention. These parameters were repeated 1 year after the surgery. GCL-IPL, RNFL parameters were compared with controls and were correlated with VF mean deviation (MD). The diagnostic power of GCL-IPL was tested using the receiver operating characteristic (ROC) curve. Healthy age and sex-matched controls without any ocular and systemic abnormality were taken for comparison.Results:Twenty-four patients qualified the inclusion criteria. A significant thinning of GCL-IPL (P = 0.002) and RNFL (P = 0.039) was noticed in the pituitary adenoma group. GCL-IPL (r = 0.780 P < 0.001) and RNFL (r = 0.669, P < 0.001) were significantly correlated with the MD. The ROC curve values of GCL-IPL were 0.859 (95% confidence interval 0.744% to 0.973) and of RNFL were 0.731 (95% confidence interval 0.585–0.877). The diagnostic ability of GCL-IPL was more as compared to the RNFL analysis, although it was statistically insignificant (P = 0.122).Conclusion:GCL-IPL measurements on the OCT are a sensitive tool to detect early anterior visual pathway changes in chiasmal compression for pituitary adenoma patients.

Endoscopic transsphenoidal surgery for resection of pituitary macroadenoma: A retrospective study.

BackgroundThe endoscopic transsphenoidal approach is an efficient minimally invasive procedure for removal of pituitary tumors that can be accomplished through a one-hand or two-hand approach. The one-hand procedure through one nostril is more intuitive for surgeons, but maneuvering the instruments can be restrictive. The two-hand procedure using a one-and-half nostril approach provides more precise manipulation. This study aimed to compare the surgical outcomes of one-hand/mono-nostril and two-hand/one-and-half nostril surgeries for resection of large pituitary tumors by a single neurosurgeon.Materials and methodsThe surgical data of 78 consecutive cases with pituitary macroadenoma (diameter >1 cm) were reviewed retrospectively. Altogether, 30 cases received one-hand/mono-nostril surgery, while 48 cases received two-hand/one-and-half nostril surgery. Postoperative outcomes of the two operations were compared.ResultsThe operative time, hospital stay, residual rate of pituitary macroadenoma, visual field, surgical complications, and re-operative rates were slightly improved in the two-hand/one-and-half nostril surgery group compared with that in the one-hand/mono-nostril surgery group (all p>0.05). However, postoperative hypopituitarism was less frequent (1/48; 2.0%) with the two-hand/one-and-half nostril approach than with the mono-nostril approach (p = 0.004). Similar surgical outcomes were found in all patients with either small or large pituitary tumors, except that the difference in postoperative improvement in visual field change reached statistical significance (p = 0.044).ConclusionA single-surgeon endoscopic endonasal transsphenoidal surgery with two-hand/one-and-half nostril approach is an effective and safe procedure for removal of large pituitary tumors.

Non-invasive electrical brain stimulation for vision restoration after stroke: An exploratory randomized trial (REVIS)

Background:Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke.Objective:We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke.Methods:In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n = 8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n = 8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm.Results:Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well.Conclusions:This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials.NCT01418820 (clinicaltrials.gov)

Nomograms for Converting Perimetric Sensitivity From Full Threshold and SITA Fast to SITA Standard in Patients With Glaucoma and Healthy Subjects.

PurposeThe purpose of this study was to develop nomograms for converting Full Threshold (FT) and Swedish Interactive Threshold Algorithm (SITA) Fast (SF) tests to SITA Standard (SS) tests with the Humphrey Field Analyzer in patients with glaucoma and healthy subjects.MethodsOne eye each of 49 patients with glaucoma and 50 healthy subjects was tested in 4 and 2 sessions (each containing the 3 strategies), respectively, over 4 weeks. The difference between pointwise Best Available Estimate (BAE; mean of all FT tests) and SS sensitivity at each session was used to derive four nomograms. Nomogram accuracy was assessed by: (1) comparing the converted FT to actual SS sensitivity (omitting the test session used to derive the nomogram) and (2) comparing the distribution of the differences between the converted and actual SS sensitivity to the actual SS test-retest differences. The process was repeated for SF and healthy subjects.ResultsIn patients with glaucoma, 39.85% and 59.69% of the conversion differences from FT were within 1 dB and 2 dB of the mean, respectively. The respective figures for SF were 45.69% and 65.04%, and in healthy subjects, they were 54.34% and 76.48% for FT and 61.17% and 82.66% for SF. The difference in the mean conversion and test-retest differences was <0.5 dB for all comparisons, with an overlap in distributions ranging from 78.75% to 85.24. There was no association between conversion differences and BAE for either FT or SF in either subject group.ConclusionsNomograms to convert FT and SF tests to SS tests yield accuracies that are negligibly different from test-retest differences with SS.Translational RelevanceNomograms allow direct comparisons between different perimetric strategies for a more comprehensive assessment of visual field change.

Macular ganglion cell complex injury in different stages of anterior ischemic optic neuropathy.

BACKGROUNDAnterior ischemic optic neuropathy (AION) is a group of ophthalmic diseases in which the optic nerve is injured causing blindness. However, the pathogenesis, clinical manifestations, and clinical treatments of AION are yet elusive. Only a few related experimental or clinical reports are available on the disease. In this study, spectral domain optical coherence tomography (SD-OCT) was used to examine the morphology of thickness swelling and atrophic changes of macular ganglion cell complex (mGCC) in the different stages of AION that were then compared with the visual fields. Thus, the clinical value of mGCC examination was alleged to be similar to that of the visual field.AIMTo explore the mGCC injury at different stages in AION and the clinical significance.METHODSCases with AION were analyzed in a retrospective study. SD-OCT was used to analyze the correlation between mGCC and peripapillary retinal nerve fiber layer thicknesses at different stages of AION and the changes in the corresponding stages of visual fields.RESULTSA total of 21 cases (28 eyes) presented AION. The onset time of AION was defined as early stage (within 3 wk of onset), middle stage (from 3 wk to 2 mo), and late stage (disease span > 2 mo). In the early stage, the mGCC thickness of SD-OCT was within the normal high limit, and the perioptic nerve fibers thickness was more than the normal. The changes in the visual field in early stage were not consistent with the swelling changes in mGCC and peri-disc nerve fibers. In addition, atrophy and thinning appeared in mGCC, and the perioptic nerve fibers were swollen. However, the thickness was lower in the middle period than that in the early stage. The change in visual field was consistent with that of mGCC in this period. In the late stage, mGCC shrank and thinned, and the thickness of the nerve fibers around the optic disc in the corresponding region shrank and thinned.CONCLUSIONThe changes in mGCC thickness in patients with AION showed early, middle, and late stages of development by SD-OCT. Although the early stage visual field changes of AION were not consistent with the swelling changes of mGCC, the horizontal delimitation or annular atrophy of mGCC was consistent with that in the middle and late stage of the disease. The atrophy of peripheral nerve fibers was later than that of the mGCC atrophy.

Optik Disk Hipoplazili Bir Çocukta Kanada Okupasyonel Perfomans Modeli’ne Göre Ergoterapi Müdahalesinin Etkinliğinin İncelenmesi: Olgu Çalışması

Optic disc hypoplasia (ODH) is a non-progressive condition that can develop unilaterally or bilaterally, with decreased retinal nerve fiber count and normally developing retinal tissue. Decreased vision, visual field changes and defects in color vision mau be seen in individuals with ODH. A 3-year-old male pediatric case with ODH in the right eye was included in the study. The Canadian Model of Occupational Performance (CMOP) was used for the holistic evaluation of the individual, environmental and ocupational factors of the case, and the Visual Perception Reference Frame was used for the intervention application. The problem areas within the scope of CMOP were determined as difficulty in holding cutlery and therefore eating by spilling food, inability to distinguish small pictures on paper, weakness in perception of color and figure-ground, and weakness in gross motor skills (standing on one leg, jumping in place). The short-term goals in the 8-week intervention plan, development of visual discrimination (recognition, matching, classification) skills, development of color perception and figure perception, increasing the level of independence in eating with the help of auxiliary equipment (thickened cutlery); the long-term goals were determined as the development of figure-ground perception, the development of visual attention and the development of visual motor integration. With the target spesicif occupational therapy intervention program, the case was able to eat independently with the help of thickened cutlery, to be able to combine simple figures, large pieces and brightly colored puzzle pieces, to increase the time to stand on one leg, and to jump on two legs. There is a need for more evidence-based occupational therapy studies including visual perception studies in diagnoses affecting the visual field such as ODH.

Correlation between Visual Field Changes and Peripapillary Vessel Density in Primary Open Angle Glaucoma

Background: Glaucoma is a progressive optic neuropathy, which is characterized by degeneration of the retinal ganglion cells. The role of optic nerve head (ONH) microvascular network and vascular dysfunction has been investigated in the pathogenesis of glaucoma. Objective: The aim of the current work was to assess the correlation between visual field changes in primary open angle glaucoma (POAG), and the density of the radial vessels around the optic disc. Patients and Methods: One hundred eyes of fifty patients were enrolled in this prospective cross-sectional study. Patients were recruited from the Department of Ophthalmology, Al-Zahraa University Hospital from December 2018 to March 2020. They were divided into two groups, control group with normal functional and structural data, and glaucomatous group with POAG. Results: There were significant differences in all measurements among both groups, including visual field indices, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters. The changes of peripapillary vessel density (PpVD) had strongly positive correlations with the mean deviation (MD), ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness, while had negative correlation with pattern standard deviation (PSD) and cup disc (C/D) ratio. Conclusion: Decreased PpVD was detected in the glaucomatous group. There were statistically significant correlations between visual field changes (changes of both MD and PSD) and PpVD where there were strongly positive correlations with the (MD), and negative correlation with PSD. This can add to the diagnosis of POAG. Also, it provided more information about the microvascular changes in the ONH and peripapillary retina in cases of POAG.

Association between central corneal thickness, intro ocular pressure and visual field changes in primary open angle glaucoma

Association between central corneal thickness, intro ocular pressure and visual field changes in primary open angle glaucoma

Pituitary apoplexy without chiasm compression: A case report.

The present report presents a rare case in which a patient with pituitary apoplexy (PA) without compression of the optic chiasm experienced diagnosable visual impairment in the ensuing months. Endocrinologically, the condition was a prolactinoma followed by bleeding into the pituitary gland. Due to the unexplained functional changes in the patient, an electrophysiological examination (pattern electroretinogram and pattern visual evoked potentials) was performed, which verified a bilateral non-inflammatory neurogenic lesion. This finding was confirmed by functional magnetic resonance imaging (fMRI) examination. Structural MRI did not reveal chiasm compression in the time sequence or alteration of the optic nerves (the diameter of the optic nerve at different distances from the eye and the diameter of the optic nerve sheath at different distances from the eye). Similarly, neither the retinal nerve fiber layer (RNFL) nor the vessel density was altered. The present report suggests that changes in visual fields may be due to ischemia in the area of the chiasm and optic nerves, similar to PA.

OCT ANGIOGRAPHY AND DOPPLER ULTRASOUND IN HYPERTENSION GLAUCOMA.

The main aim of this work was to find out if there is acorrelation between vessel density (VD) and results of measured perfusion values in ophthalmic artery and in central retinal artery of the same eye in agroup with hypertension glaucoma (HTG). The file included 20 patients with HTG, thereof 13 women of average age 68.7 years (49-80 years) and 7 men of average age 58.4 years (27-81 years). Criteria for inclusion in the study: visual acuity 1,0 with possible correction less than ±3 diopters, approximately the same changes in visual fields in every patient, intraocular pressure (IOP) less than 18 mmHg, no other ocular or neurological diseases. VD was measured by Avanti RTVue XR by Optovue firm, perfusion parameters were measured using Doppler ultrasound with Affinity 70G machine by Philips firm. The peak systolic velocity (PSV) and end diastolic velocity (EDV) and resistance index (RI) were measured both in ophthalmic artery (AO) and in central retinal artery (CRA). Visual field (VF) was examined by quick threshold glaucoma program by Medmont M 700 machine. The sum of sensitivities in apostilbs (abs) was evaluated in the range 0-22 degrees of visual field. The results of sensitivities in visual field were compared to VD and perfusion parameters in CRA and AO of the same eye. Pearsonscorrelation coefficient (p=0,05) was used to assess the dependency between chosen parameters. By comparing VF and VD from measured areas, strong correlation (r=0.64, resp. 0.65) was revealed. It was then proved that VD (WI-VDs) correlates with RICRA weakly (r=-0.35) and moderately strongly (WI-VDa r=-0.4, PP-VDs r=-0.43 and PP-VDa r=-0.45). This means that with increasing resistance index in CRA the density in VD decreases. The other correlations between VD and perfusion parameters (PSV and EDV) in CRA and AO were not significant. Measured values showed that the vascular component of VD has ahuge impact on the changes in visual fields in HTG. Weak to moderate influence exists between VD and RI in CRA. OCTA has proven to be more suitable than Doppler ultrasound for determining the condition of blood circulation in the eye.

Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

BackgroundHydroxychloroquine (HCQ) is an antimalarial drug, recently used in COVID-19 treatment. Also it is considered over many years the cornerstone in treating systemic lupus erythematosus (SLE) in adults and children. The incidence of retinal affection and retinal toxicity from hydroxychloroquine is rare, but even after the HCQ is stopped, loss of vision may not be reversible and may continue to progress. Fundus autofluorescence (FAF) is one of the screening methods recommended by AAO used for the diagnosis of hydroxychloroquine retinopathy. Our aim is to detect early HCQ-induced retinopathy among SLE patients and the risk factors for its development by using fundus autofluorescence.ResultsIn the present study, 11.3% of the studied patients had significant visual field changes upon testing. Of those, 6.3% had abnormal fundus autofluorescence. We found a significant statistical relation between hydroxychloroquine retinopathy and the duration and cumulative dose of hydroxychloroquine therapy (p value = 0.003) and decreased best-corrected visual acuity of both eyes (p value = 0.000). There was no relationship between HCQ retinopathy detected by fundus autofluorescence and daily dose of HCQ/kg, age, sex, and SLEDAI score.ConclusionFrequency of SLE patients who had confirmed HCQ-induced retinopathy was 6.3%. Hydroxychloroquine could be safely used in all SLE patients regardless of age, sex, and SLE activity. Routine ophthalmological assessment is recommended for SLE patients who received HCQ especially for those who received HCQ longer than 7 years. Fundus autofluorescence is a modern objective tool which is specific for the early detection of HCQ retinopathy.

Biomechanical Glaucoma Factor and Corneal Hysteresis in Treated Primary Open-Angle Glaucoma and Their Associations With Visual Field Progression.

PurposeTo investigate the relationship between biomechanical glaucoma factor (BGF) measured with Corvis ST and glaucomatous visual field (VF) progression, compared to corneal hysteresis (CH) measured with ocular response analyzer using a longitudinal dataset of primary open-angle glaucoma (POAG). The discriminative powers of BGF and CH were also compared using a cross-sectional dataset.MethodsThe longitudinal dataset included 166 POAG eyes. The rate of VF change during the follow-up period was evaluated using the mean of 52 pointwise total deviations in the Humphrey 24-2 field test. Variables associated with the VF progression rate were identified from BGF, CH, age, baseline VF severity, and intraocular pressure during the VF follow-up period by identifying the optimal model. The cross-sectional dataset included 68 POAG eyes and 68 healthy eyes. Using this dataset, the area under the curve (AUC) values of the receiver-operating curve were compared between CH and BGF.ResultsThe optimal multivariate linear mixed model to describe the VF rate included age and CH, but not BGF. Between POAG and healthy eyes, CH was statistically different (P < 0.001), although this was not the case with BGF. The AUC values were 0.61 and 0.71 for BGF and CH, respectively (P = 0.027).ConclusionsCH, but not BGF, was associated with VF progression in POAG patients under treatment. BGF was not useful to discriminate POAG between treated and normal eyes.

Influence of ACPA-positive rheumatoid arthritis on visual field testing in patients with arterial hypertension: A comparative cross-sectional study.

PurposeTo evaluate a possible influence of anti‐cyclic citrullinated peptide autoantibodies (ACPA) ‐ positive rheumatoid arthritis (RA) on visual field (VF) testing in patients with arterial hypertension (aHT).MethodsWe conducted an observational cross‐sectional study comparing patients with ACPA‐positive RA and aHT, patients with aHT and healthy subjects. Further inclusion criteria were visual acuity (VA) of 0.8 or better and age between 40 and 60 years. VF testing was performed with standard automated achromatic perimetry (SAP), short wavelength automated perimetry (SWAP) (Octopus 300®) and flicker perimetry (Pulsar®). Results were analysed for a possible correlation with blood pressure or RA‐activity.ResultsTwenty subjects with RA and aHT, 26 patients with aHT and 22 healthy participants were examined. Significant differences were found for mean sensitivity (MS) in SWAP comparing RA‐patients with healthy participants (ΔMS −3.06, p = 0.001) and with hypertensive patients (ΔMS −2.32, p = 0.007). In SAP we observed a significant difference between patients with RA and healthy subjects regarding loss variance (LV) (ΔLV = +9.77, p = 0.004). Flicker perimetry did not demonstrate significant differences between groups. A correlation of VF changes with blood pressure level or RA‐activity was not observed.ConclusionPatients with ACPA‐positive RA and aHT showed significant impairment of VF performance in SWAP compared to patients with aHT alone and healthy subjects. SAP also revealed a significant difference of LV between RA‐patients and healthy subjects. aHT does not seem to induce functional changes in VF testing alone.

Retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after orbital decompression for dysthyroid optic neuropathy.

To determine the prognostic value of optical coherence tomography (OCT) measurement of the peripapillary retinal nerve fiber layer (RNFL) thickness in visual recovery after orbital decompression of patients with dysthyroid optic neuropathy (DON). A total of 52 eyes of 37 patients who underwent orbital decompression for DON between 2013 and 2019 were retrospectively reviewed. We examined peripapillary RNFL thickness, best-corrected visual acuity (BCVA), visual field (VF) for mean deviation (MD) and pattern standard deviation (PSD), and pattern-reversed visual evoked potential (PVEP) for P100 latency and amplitude before and after surgery. Black and white checkerboard square sizes of PVEP were 15 and 60 arcmin (arcminute and minute of angle). Changes in RNFL overall thickness and by quadrant and interocular differences were evaluated and studied regarding changes in BCVA, VF and PVEP. There was a significant improvement in BCVA, VF, and PVEP, whereas a dramatic reduction in RNFL thickness of all DON patients in global average, temporal, superior, and inferior quadrants (P = 0.005, P = 0.024, P = 0.016, and P = 0.001, respectively) after decompression surgery, except for nasal quadrant (P = 0.057). The preoperative RNFL thickness in each quadrant was negatively correlated with postoperative changes of BCVA and PSD and positively correlated with changes of MD and P100 amplitude at 60 arcmin (all P < 0.05). Except for temporal quadrant (P = 0.125), the preoperative RNFL thickness in other quadrants was positively correlated with postoperative changes of P100 amplitude at 15 arcmin (all P < 0.05). The nasal RNFL thickness was an excellent predictor for improvement in BCVA by 20/25 or better and in MD by 10dB or more after surgery, whose cutoff value was 73.50μm, while the inferior and superior RNFL thickness could act as a predictor for improvement in P100 amplitude by 5μV or more at 60 arcmin and at 15 arcmin, respectively, whose cutoff value was, respectively, 143.00μm and 130.50μm (all P < 0.05). RNFL thickness measured by OCT was correlated with visual function recovery after decompression surgery in patients with DON, which could also act as a predictor for better visual prognosis.

When One Autoimmune Condition Predisposes You to Another!

Introduction: Lymphocytic hypophysitis (LYH) is an autoimmune condition in which pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages. It is more common in pregnant and postpartum women, presenting with headache, visual field changes and one or more pituitary hormone impairment.Case Presentation: 32year-old female recently diagnosed with RA complicated by uveitis, presented to our facility with headache, shortness of breath, blurred vision and dysphagia. MRI head revealed a 1.9cm sellar mass with suprasellar extension displacing the optic chiasm. There was clear thickening of the pituitary stalk which raised suspicion for autoimmune hypophysitis. Exam in the ED revealed an anxious female wit hypertension, tachycardia and BMI 30. The rest of the physical exam was unremarkable. Her pituitary gonadal axis workup revealed panhypopituitarism with TSH 0.01uIU/ml, FSH <0.3Miu/ml, LH <0.3mIU/ml, ACTH <5pg/ml, IGF-1 31ng/ml and prolactin 14.4ng/ml. She was started on prednisone 50mg daily and on levothyroxine 150mcg daily. On day 2, she developed polyuria and the work up revealed a serum sodium of 146 meq/L, serum osmolality 315mOsm/kg, urine osmolality 281mOsm/kg and urine output 5.6L in 24hrs. The diagnosis of DI was made and she was started on desmopressin. On day 7, the serum sodium normalized and she did not require any other dose of desmopressin. On the day of discharge, a repeat MRI head was done which showed reduced enhancement of the pituitary which was reassuring.Discussion: LYH is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary gland with various degrees of pituitary dysfunction. Associated autoimmune diseases are seen in 18%– 50% of cases of AH. The most commonly-associated disease is autoimmune thyroid disease (15%–25%), while concurrent autoimmune conditions including RA are reported as well. Homogenous symmetrical enlargement of the pituitary gland, a thickened non deviated stalk, and a prompt, intense and homogenous enhancement of the mass after gadolinium contrast are the characteristic findings on MRI. Spontaneous resolution is the usual course and surgery is indicated only when the symptoms of sellar compression are serious and progressive.Conclusion: LYH is predominantly a disease of young females. We present this case in order to create awareness about the co-existence of LH with other autoimmune conditions and its usual course of regression with steroids.

Central visual field change after fornix-based trabeculectomy in Japanese normal-tension glaucoma patients managed under 15mmHg.

To investigate how the central visual field would be changed after fornix-based trabeculectomy with mitomycin C in Japanese normal-tension glaucoma (NTG) patients monitored for more than 10years including before surgery. This is a retrospective cohort study. We identified twenty-eight eyes of 28 NTG cases regularly monitored for more than 5years and examined static visual field (VF) tests for more than five times before and after fornix-based trabeculectomy (including combined surgery). Based on preoperative data for 6.3years, we evaluated postoperative changes for 6.0years in 10-2 VF and 30-2 VF. Six patients were male and 22 females, the mean age was 57.9years, and the mean deviation was - 13.7 decibels. After surgery, mean IOP decreased from 13.9 to 9.0mmHg (P ≤ 0.01), and medication score also did. The rate of 10-2 VF deterioration was significantly suppressed from - 1.0dB/year preoperatively to - 0.4dB/year postoperatively (P ≤ 0.01). And when 30-2 VF was divided into six relevant sectors, the rate of deterioration at cecocentral and arcuate areas of the superior hemifield was suppressed postoperatively (P ≤ 0.01 and P = 0.042, respectively). Based on long-term preoperative data, a significant positive change in 10-2 VF was observed after fornix-based trabeculectomy with mitomycin C in Japanese NTG patients with a mean IOP of 13.9mmHg. Central vision could be expected to be maintained for NTG patients even if its preoperative IOP is low after successful trabeculectomy.

Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review.

Phosphodiesterase type 5 inhibitors such as sildenafil citrate and tadalafil are well known for the treatment of erectile dysfunction. However, their use in the presence of pulmonary hypertension can cause ophthalmologic side effects, including non-arteritic optic ischemic neuropathy, chorioretinopathy, glaucoma, and optic atrophy. The present review aimed to identify these visual side effects and provide recommendations. We identified articles published from January 2000 to March 2019 on diseases arising from the management of sexual dysfunction in urology or pulmonary hypertension in pneumonia that could cause pathologic alterations in eye structure based on a literature search of the MEDLINE electronic database using keywords for the most common adverse effects and different kinds of phosphodiesterase 5 inhibitors. After applying the exclusion criteria, we selected 36 of the 77 articles initially identified to write the narrative review and added 20 additional articles to completely describe the pathological entities. Phosphodiesterase type 5 inhibitors can cause side effects in the eye including ocular surface abnormalities, increased intraocular pressure and glaucoma, uveitis, non-arteritic ischemic neuropathy, chorioretinopathy, retinal occlusion, and visual field changes. There is an increased need for well-performed studies to better understand these side effects, which are common due to the wide use of sildenafil.

Perifoveal Chorioretinal Atrophy after Subretinal Voretigene Neparvovec-rzyl for RPE65-Mediated Leber Congenital Amaurosis

To report an anatomic change following subretinal injection of voretigene neparvovec-rzyl (VN) for RPE65-mediated Leber congenital amaurosis. Multicenter, retrospective chart review. Patients who underwent subretinal VN injection at each of 4 participating institutions. Patients were identified as having perifoveal chorioretinal atrophy if (1) the areas of atrophy were not directly related to the touch-down site of the subretinal cannula; and (2) the area of atrophy progressively enlarged over time. Demographic data, visual acuity, refractive error, fundus photographs, OCT, visual fields, and full-field stimulus threshold (FST) were analyzed. Outcome measures included change in visual acuity, FST, visual fields, and location of atrophy relative to subretinal bleb position. A total of 18 eyes of 10 patients who underwent subretinal injection of VN were identified as having developed perifoveal chorioretinal atrophy. Eight of 10 patients (80%) developed bilateral atrophy. The mean age was 11.6 years (range, 5-20 years), and 6 patients (60%) were male. Baseline mean logarithm of the minimum angle of resolution visual acuity and FST were 0.82 (standard deviation [SD], 0.51) and-1.3 log cd.s/m2 (SD, 0.44), respectively. The mean spherical equivalent was-5.7 diopters (D) (range,-11.50 to+1.75 D). Atrophy was identifiable at an average of 4.7 months (SD, 4.3) after surgery and progressively enlarged in all cases up to a mean follow-up period of 11.3 months (range, 4-18 months). Atrophy developed within and outside the area of the subretinal bleb in 10 eyes (55.5%), exclusively within the area of the bleb in 7 eyes (38.9%), and exclusively outside the bleb in 1 eye (5.5%). There was no significant change in visual acuity (P= 0.45). There was a consistent improvement in FST with a mean improvement of-3.21 log cd.s/m2 (P < 0.0001). Additionally, all 13 eyes with reliable Goldmann visual fields demonstrated improvement, but 3 eyes (23.1%) demonstrated paracentral scotomas related to the atrophy. A subset of patients undergoing subretinal VN injection developed progressive perifoveal chorioretinal atrophy after surgery. Further study is necessary to determine what ocular, surgical delivery, and vector-related factors predispose to this complication.