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ABSTRACT: BACKGROUND:: Pseudotumor cerebri (PTC) is characterized by raised intracranial pressure (ICP) without an identifiable mass, evidence of hydrocephalus, or abnormal cerebrospinal fluid content. In the past, most cases of PTC appeared to have no identifiable etiology, and thus, they were classified as "idiopathic intracranial hypertension" (IIH). Recently, however, a subset of patients with presumed IIH has been found to have evidence of cerebral dural sinus stenoses, particularly involving one or both transverse sinuses (TS). The belief that the stenoses are the cause, rather than an effect of the increased ICP, has led investigators to recommend stenting of the stenosed sinus for the treatment of the condition. We describe detailed visual and neurological outcomes after stenting for PTC associated with hemodynamically significant dural sinus stenosis. METHODS:: All patients with PTC had initial neurological, neuro-ophthalmological, and imaging assessments. Regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance or computed tomographic venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient (MPG) of 4 mm Hg or greater was present, unilateral transverse sinus stenting was performed. RESULTS:: Twelve patients with PTC and TS stenosis associated with an MPG of >4 mm Hg who failed medical therapy were identified. TS stenting significantly decreased the pressure gradient in all cases. Unilateral stenting was sufficient to reduce pressure gradients even when the stenosis was bilateral. At a mean follow-up of 16 months (range, 9-36 months), tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven patients had significant improvement in headaches. CONCLUSION:: In this small series of patients with PTC associated with TS stenosis, endovascular stent placement was generally effective in treating visual dysfunction and tinnitus, although not headaches. The optimum gradient and vascular characteristics amenable for selection of patients for stenting needs further research.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 03/2013; · 1.09 Impact Factor
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ABSTRACT: To determine the anatomic and visual outcomes of patients with ophthalmic artery segment aneurysms treated at The Johns Hopkins Hospital using a consensus-based treatment algorithm.
Retrospective record review of a prospectively accrued case series of 88 patients (101 aneurysms) treated between January 2004 and July 2009. Presenting symptoms and aneurysm parameters were recorded for all subjects. Treatment strategy for all patients was determined by consensus among neurosurgeons, neurointerventionalists, neurologists, and neuroophthalmologists meeting to review the clinical cases on a weekly basis. Final clinical outcomes (aneurysm control, functional status, and vision) were ascertained from in-house examinations, medical records, telephone interviews, or a combination of these methods. Risk factors for visual or other complications were evaluated.
An optic neuropathy was present in at least 30 (34%) of 88 patients after treatment. Presumed new visual loss occurred in 24 (27%) of these patients. The remaining 6 patients had preexisting optic neuropathy-related visual loss that worsened after treatment. No patient with a preexisting optic neuropathy improved following treatment.
Ophthalmic artery segment aneurysms present a treatment challenge because of their anatomic complexity and relationship to critical neural structures, particularly the visual sensory pathway. We have adopted a consensus-based treatment approach in an effort to optimize patient outcomes and aneurysm control. Although our approach resulted in durable treatment of the aneurysm, a sizable proportion of patients experienced new vision loss after treatment, and no patient with preexisting visual loss related to their aneurysm experienced visual improvement after treatment. We recommend that all patients with ophthalmic artery aneurysms receive careful and thorough preprocedural counseling to ensure they are aware of the risks and benefits of treatment regardless of the method used.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 12/2011; 32(1):27-32. · 1.09 Impact Factor
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ABSTRACT: To correlate potential inflammatory responses in nonarteritic anterior ischemic optic neuropathy (NAION) with a lesion possessing many physiologic and histologic similarities from a model of nonhuman primate NAION (pNAION).
Using immunohistochemistry and confocal microscopic analysis, we evaluated the relative numbers of inflammatory cell types in the single available clinical specimen of early NAION (21 days after event). We correlated this with the temporal inflammatory response occurring in optic nerve tissue at different times following pNAION induction.
In pNAION, there is a previously unsuspected infiltration of polymorphonuclear leukocytes occurring almost immediately after infarct induction, followed by invasion of ED1+ extrinsic macrophages, which peaks 5 weeks after infarct. Intrinsic microglia accumulate up to 70 days after induction in the area of primary axonal loss. The analyzed human NAION specimen was similar to 21-day pNAION tissue, with extrinsic macrophages and intrinsic microglial cells in the region of focal axon loss.
Cellular inflammation plays a major early role following white-matter (optic nerve) infarct, with both polymorphonuclear leukocyte and macrophage function involved in debris elimination and tissue remodeling. The optic nerve in NAION and its primate model are associated with early cellular inflammation, previously unsuspected, that may contribute to postinfarct optic nerve damage.
Archives of ophthalmology 12/2011; 129(12):1583-91. · 3.86 Impact Factor
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ABSTRACT: To develop an automated neurologic hemifield test (NHT) to detect visual field loss caused by chiasmal or postchiasmal lesions.
Visual field locations from 24-2 pattern automated visual fields were grouped into two symmetric regions with 16 points on either side of the vertical meridian. A scoring system similar to the Glaucoma Hemifield Test (GHT) was used to calculate point scores using the pattern deviation values from the right and left regions. The cross-vertical difference in the sum of these values was the NHT score. The NHT was evaluated using visual fields from subjects with known neurologic disease, subjects with glaucoma, and glaucoma suspects (92 pairs of eyes each). The NHT score was calculated for each eye. Four masked reviewers scored all pairs of visual fields with regard to the likelihood of neurologic and glaucomatous optic neuropathy. Both NHT score and expert field ratings were compared with clinical diagnosis by receiver operating characteristic (ROC) analysis.
The NHT effectively discriminated neurologic fields from those of glaucoma patients and glaucoma suspects (area under the ROC curve [AUC] = 0.90; 95% confidence interval [CI], 0.86-0.94). The NHT score correlated well with clinician grading (Pearson correlation estimates, 0.74-0.78). Even when field defects were subtle, the NHT had some ability to discriminate neurologic from nonneurologic fields (AUC 0.68; 95% CI, 0.56-0.79).
The NHT distinguished neurologic field defects from those of glaucoma and glaucoma suspects, rivaling the performance of subspecialist clinicians. Its implementation may help identify unsuspected neurologic disease.
Investigative ophthalmology & visual science 09/2011; 52(11):7959-65. · 3.43 Impact Factor
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ABSTRACT: To demonstrate the utility of orbital ultrasound in the evaluation and management of suspected orbital vascular lesions.
Clinical case series of 15 patients with suspected orbital vascular lesions seen in the Neuro-ophthalmology clinic of the Wilmer Eye Institute. The techniques of standardized echography (combined use of a contact B-scan and standardized A-scan) were performed by an experienced echographer, and data obtained were compared with other available imaging modalities to determine appropriate management. Patients were monitored for improvement, stability, or worsening of symptoms and signs.
Based on echographic data obtained, 6 patients underwent surgery, 9 were observed over a follow-up period of 0-14 (mean 3.3) years. All patients demonstrated improvement or remained stable, and no complications developed from misdiagnosis during subsequent follow-up.
Orbital ultrasound provides reliable imaging parameters and can be used as the primary imaging modality when evaluating suspected orbital vascular lesions.
Ophthalmic plastic and reconstructive surgery 07/2011; 27(6):431-5. · 0.69 Impact Factor
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Neil R Miller
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 06/2011; 31(2):e1-3. · 1.09 Impact Factor
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Archives of ophthalmology 06/2011; 129(6):813-4. · 3.86 Impact Factor
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ABSTRACT: To provide the long-term outcomes of patients treated with fractionated conformal radiotherapy (FCRT) for presumed optic nerve sheath meningiomas (ONSMs).
Between 1995 and 2002, 9 patients with a presumed ONSM were treated with FCRT at our institution. The indications for FCRT were significant visual dysfunction at presentation, progression of visual dysfunction during a period of observation, tumor growth documented by sequential imaging, or a combination of these findings. In 2 patients, FCRT was performed as adjuvant therapy, and in 7, it was the initial and primary treatment.
Of the 9 patients, 6 were women and 3 were men, with a mean age of 47 years. All 9 patients had evidence of optic nerve dysfunction in the affected eye, characterized by reduced visual acuity, a visual field defect, and a relative afferent pupillary defect. In addition, 2 patients had proptosis and 1 had diplopia. The mean follow-up period was 98 ± 31.7 months (median, 90; range, 61-151). After FCRT, the visual function improved in the 7 patients who had undergone FCRT as the primary treatment. However, 2 patients who were blind in their affected eye at FCRT remained blind. In 4 of the 7 patients with improvement, the improvement was documented within 1-3 months after FCRT. The tumor control rate was 100%. Proptosis and diplopia also regressed in 100% of patients. At 2 years after FCRT, 1 patient had developed radiation retinopathy.
The results of our study have shown that FCRT is a safe and effective treatment of ONSMs, affording satisfactory long-term tumor control, good functional outcome, and low treatment morbidity. FCRT should be considered the treatment of choice for patients with presumed ONSMs for whom the treatment has been deemed appropriate.
International journal of radiation oncology, biology, physics 05/2011; 80(1):185-92. · 4.59 Impact Factor
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ABSTRACT: Anterior ischemic optic neuropathy (AION) can be divided into nonarteritic (NAION) and arteritic (AAION) forms. NAION makes up ~85% of all cases of AION, and until recently was poorly understood. There is no treatment for NAION, and its initiating causes are poorly understood, in part because NAION is not lethal, making it difficult to obtain fresh, newly affected tissue for study. In-vivo electrophysiology and post-mortem studies reveal specific responses that are associated with NAION. New models of NAION have been developed which enable insights into the pathophysiological events surrounding this disease. These models include both rodent and primate species, and the power of a 'vertically integrated' multi-species approach can help in understanding the common cellular mechanisms and physiological responses to clinical NAION, and to identify potential approaches to treatment. The models utilize laser light to activate intravascular photoactive dye to induce capillary vascular thrombosis, while sparing the larger vessels. The observable optic nerve changes associated with rodent models of AION (rAION) and primate NAION (pNAION) are indistinguishable from that seen in clinical disease, including sectoral axonal involvement, and in-vivo electrophysiological data from these models are consistent with clinical data. Early post-infarct events reveal an unexpected inflammatory response, and changes in intraretinal gene expression for both stress response, while sparing outer retinal function, which occurs in AAION models. Histologically, the NAION models reveal an isolated loss of retinal ganglion cells by apoptosis. There are changes detectable by immunohistochemistry suggesting that other retinal cells mount a brisk response to retinal ganglion cell distress without themselves dying. The optic nerve ultimately shows axonal loss and scarring. Inflammation is a prominent early histological feature. This suggests that clinically, specific modulation of inflammation may be a useful approach to NAION treatment early in the course of the disease.
Progress in Retinal and Eye Research 03/2011; 30(3):167-87. · 9.45 Impact Factor
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ABSTRACT: Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive malignancy that occurs on the face, can invade deep tissue, and can rarely invade the orbit via perineural spread. It has been reported most often in the form of a cutaneous lesion. Although there have been 3 prior case reports of an orbital presentation of MAC, all have been from undiagnosed cutaneous or subcutaneous lesions. We report a rare case of a primary orbital MAC in a 39-year-old healthy woman who presented with progressive diplopia and enophthalmos without evidence of any cutaneous or subcutaneous lesions.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 02/2011; 31(2):147-50. · 1.09 Impact Factor
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ABSTRACT: Autosomal-dominant optic atrophy (DOA) is one of the most common inherited optic neuropathies, and it is genetically heterogeneous, with mutations in both OPA1 and OPA3 known to cause disease. Approximately 60% of cases harbor OPA1 mutations, whereas OPA3 mutations have been reported in only 2 pedigrees with DOA and premature cataracts. The aim of this study was to determine the yield of OPA1 and OPA3 screening in a cohort of presumed DOA cases referred to a tertiary diagnostic laboratory.
Retrospective case series.
One hundred eighty-eight probands with bilateral optic atrophy referred for molecular genetic investigations at a tertiary diagnostic facility: 38 patients with an autosomal-dominant pattern of inheritance and 150 sporadic cases.
OPA1 and OPA3 genetic testing was initially performed using polymerase chain reaction-based sequencing methods. The presence of large-scale OPA1 and OPA3 genomic rearrangements was assessed further with a targeted comparative genomic hybridization microarray platform. The 3 primary Leber hereditary optic neuropathy (LHON) mutations, m.3460G→>A, m.11778G→A, and m.14484T→C, also were screened in all patients.
The proportion of patients with OPA1 and OPA3 pathogenic mutations. The clinical profile observed in molecularly confirmed DOA cases.
Twenty-one different OPA1 mutations were found in 27 (14.4%) of the 188 probands screened. The mutations included 6 novel pathogenic variants and the first reported OPA1 initiation codon mutation at c.1A→T. An OPA1 missense mutation, c.239A→G (p.Y80C), was identified in an 11-year-old black girl with optic atrophy and peripheral sensorimotor neuropathy in her lower limbs. The OPA1 detection rate was significantly higher among individuals with a positive family history of visual failure (50.0%) compared with sporadic cases (5.3%). The primary LHON screen was negative in the patient cohort, and additional molecular investigations did not reveal any large-scale OPA1 rearrangements or OPA3 genetic defects. The mean baseline visual acuity for the OPA1-positive group was 0.48 logarithm of the minimum angle of resolution (units mean Snellen equivalent, 20/61; range, 20/20-20/400; 95% confidence interval, 20/52-20/71), and visual deterioration occurred in 54.2% of patients during follow-up.
OPA1 mutations are the most common genetic defects identified in patients with suspected DOA, whereas OPA3 mutations are very rare in isolated optic atrophy cases.
Ophthalmology 10/2010; 118(3):558-63. · 5.45 Impact Factor
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ABSTRACT: Using laser-induced photoactivation of intravenously administered rose Bengal in rats, we generated an ischemic infarction of the intrascleral portion of the optic nerve (ON) comparable to that which occurs in humans to investigate optic nerve axon degenerative events following optic nerve infarct and the potential for axon re-growth. Animals were euthanized at different times post infarct. Axon degeneration was evaluated with SMI312 immunolabeling, and GAP-43 immunostaining was used to identify axon regeneration. Terminal dUTP nick end labeling (TUNEL) was used to evaluate retinal ganglion cell (RGC) death. There was significant axon structural disruptinot ion at the anterior intrascleral portion of the ON by 3d post-infarct, extending to the posterior ON by 7d post-stroke. Destruction of normal axon structure and massive loss of axon fibers occurred by 2 weeks. GAP-43 immunoreactivity occurred in the anterior ON by 7d post-infarct, lasting 3-4 weeks, without extension past the primary ischemic lesion. TUNEL-positive cells in the RGC layer appeared by 7d post-insult. These results indicate that following induction of ischemic optic neuropathy, significant axon damage occurs by 3d post-infarct, with later neuronal death. Post-stroke adult rat retinal ganglion cells attempt to regenerate their axons, but this effort is restricted to the unmyelinated region of the anterior ON. These responses are important in understanding pathologic process that underlies human non-arteritic anterior ischemic optic neuropathy (NAION) and may guide both the appropriate treatment of NAION and the window of opportunity for such treatment.
Experimental Eye Research 08/2010; 91(2):286-92. · 3.26 Impact Factor
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ABSTRACT: To investigate the visual outcomes in acute central retinal artery occlusion (CRAO) with current standard therapy at two university teaching hospitals.
Retrospective analysis of two cohorts of CRAO patients from John Hopkins Hospital (JHH; USA), and Flinders Medical Centre (FMC; Australia), treated with current standard therapy. The outcome measures were visual acuity, and subsequent ocular and systemic ischaemic events.
The mean follow-up period was 11.2 +/- 13.1 months in the JHH cohort and 35.4 +/- 34.9 months in the FMC cohort. The frequency distribution of vascular risk factors and the incidence of subsequent ischaemic events were similar for the patients from both institutions. All patients from JHH were treated as inpatients, whereas 79% of patients from FMC were treated as outpatients. More patients in the JHH cohort underwent paracentesis, ocular massage or were treated with intraocular hypotensive agents (76%) than in the FMC cohort (26%); however, there was no significant difference in visual outcome between the two cohorts (P = 0.114).
Despite differences in management of CRAO between two institutions in different countries, visual outcomes were similar. This suggests a lack of efficacy of current standard treatment in acute CRAO.
Clinical and Experimental Ophthalmology 07/2010; 38(5):496-501. · 1.98 Impact Factor
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ABSTRACT: Background: To investigate the visual outcomes in acute central retinal artery occlusion (CRAO) with current standard therapy at two university teaching hospitals.Methods: Retrospective analysis of two cohorts of CRAO patients from John Hopkins Hospital (JHH; USA), and Flinders Medical Centre (FMC; Australia), treated with current standard therapy. The outcome measures were visual acuity, and subsequent ocular and systemic ischaemic events.Results: The mean follow-up period was 11.2 ± 13.1 months in the JHH cohort and 35.4 ± 34.9 months in the FMC cohort. The frequency distribution of vascular risk factors and the incidence of subsequent ischaemic events were similar for the patients from both institutions. All patients from JHH were treated as inpatients, whereas 79% of patients from FMC were treated as outpatients. More patients in the JHH cohort underwent paracentesis, ocular massage or were treated with intraocular hypotensive agents (76%) than in the FMC cohort (26%); however, there was no significant difference in visual outcome between the two cohorts (P = 0.114).Conclusion: Despite differences in management of CRAO between two institutions in different countries, visual outcomes were similar. This suggests a lack of efficacy of current standard treatment in acute CRAO.
Clinical and Experimental Ophthalmology 06/2010; 38(5):496 - 501. · 1.98 Impact Factor
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ABSTRACT: Meningiomas represent approximately 4% of all intraorbital tumors and can arise from the optic nerve or extend into the orbit from adjacent structures.
To examine a cohort of intraorbital meningiomas and use the current World Health Organization (WHO) scheme to assess the effect of changes to the classification of tumors at this site.
The histopathology and clinical findings of intraorbital meningiomas resected between 1968 and 2008 at our institution were reviewed according to the WHO 2007 classification scheme.
A total of 51 intraorbital meningiomas were reviewed. The mean age at presentation was 45 years, but 5 tumors arose in children. Two patients were known to have neurofibromatosis type 2, and 1 had inherited retinoblastoma. Orbital meningiomas were more frequently encountered in women (30 cases) than in men (21 cases). In 21 patients, the tumor was associated with the optic nerve. The most common (25 of 51 tumors; 49%) histopathologic subtype was meningothelial. Most (47 of 51; 92%) of the tumors were WHO grade I. Four tumors (8%) were WHO grade II, with 4 or more mitotic figures per 10 high-power fields, brain invasion, chordoid histology, or a combination of these features.
Intraorbital meningiomas were most frequently of the meningothelial or transitional subtypes and were WHO grade I. One relatively common intracranial subtype, fibrous meningioma, was not encountered. The percentage of WHO grade II tumors in the orbit (8%) is similar to that reported for intracranial tumors using the current grading scheme.
Archives of pathology & laboratory medicine 05/2010; 134(5):766-70. · 2.58 Impact Factor
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ABSTRACT: To report a case of severe reversible vision loss in a woman with a 7-year history of anorexia nervosa, purging type, alcohol abuse and a severely restricted, vitamin-deficient diet.
Psychiatric, ophthalmologic, and medical records were reviewed, and a literature search was performed on visual complications associated with anorexia nervosa and malnutrition.
Ophthalmologic complications of malnutrition are rare but include both oculomotor and visual sensory disturbances. Thiamine deficiency can cause both types of disorders. Vitamin B12 and folate deficiencies are typically associated with optic neuropathy. Clinicians treating eating disorders should be aware of the potential for vitamin deficiencies and associated visual loss in patients with anorexia nervosa. This case highlights the importance of a detailed dietary history to guide vitamin rehabilitation and to minimize or reverse nutritional visual loss.
International Journal of Eating Disorders 02/2010; 44(3):281-3. · 2.95 Impact Factor
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ABSTRACT: Fisher syndrome (FS) is an acute polyneuropathy typically characterized by the triad of ataxia, areflexia, and ophthalmoplegia, although it may present with 2 or even just 1 of these clinical findings. Similarities between FS and other acute polyneuropathies such as Guillain-Barré syndrome (GBS) and Bickerstaff brainstem encephalitis (BBE) suggest that FS is part of a spectrum of autoimmune disorders that may affect the peripheral and/or central nervous system. Anti-GQ1b antibody is present in the serum of more than 85% of patients with FS, but it is not specific to FS. Why some patients develop FS and others develop typical GBS or one of its other variants is still largely unknown.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 12/2009; 29(4):312-24. · 1.09 Impact Factor
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ABSTRACT: To identify clinical and pupillographic features of patients with a relative afferent pupillary defect (RAPD) without visual acuity or visual field loss caused by a lesion in the dorsal midbrain.
Experimental study.
Four patients with a dorsal midbrain lesion who had normal visual fields and a clinically detectable RAPD.
The pupil response from full-field and hemifield light stimulation over a range of light intensities was measured by computerized binocular pupillography.
The mean of the direct and consensual pupil response to full-field and hemifield light stimulation was plotted as a function of stimulus light intensity.
All 4 subjects showed decreased pupillographic responses at all intensities to full-field light stimulation in the eye with the clinical RAPD. The pupillographic responses to hemifield stimulation showed a homonymous pattern of deficit on the side ipsilateral to the RAPD, similar to that observed in a previously reported patient with an optic tract lesion.
The basis of a midbrain RAPD is the nasal-temporal asymmetry of pupillomotor input that becomes manifest when a unilateral postchiasmal lesion interrupts homonymously paired fibers traveling in the contralateral optic tract or midbrain pathway to the pupillomotor center, respectively. The pupillographic characteristics of an RAPD resulting from a dorsal midbrain lesion thus resemble those of an RAPD resulting from a unilateral optic tract lesion, but without the homonymous visual field defect.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology 11/2009; 117(1):175-9. · 5.45 Impact Factor
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ABSTRACT: Purpose. To compare optic disc topography performed by confocal laser ophthalmoscopy in eyes with nonarteritic anterior ischemic optic neuropathy (NAION), arteritic anterior ischemic optic neuropathy (AAION), and open-angle glaucoma (OAG), adjusting for the amount of retinal ganglion cell (RGC) loss, as measured by nerve fiber layer (NFL) thickness and average visual field loss. Methods. At four referral centers, patients who met specific diagnostic criteria for OAG (103 persons, 152 eyes), NAION (53 persons, 57 eyes), or AAION (18 persons, 20 eyes) underwent Heidelberg Retinal Tomography (HRT; Heidelberg Engineering, Heidelberg, Germany), Stratus Optical Coherence Tomography (OCT; Carl Zeiss Meditec, Inc., Dublin, CA), and Humphrey visual field testing (HFA; Carl Zeiss Meditec, Inc.). HRT parameters were compared in univariate and multivariate models, accounting for degree of RGC loss by either OCT NFL thickness or visual field mean deviation (MD). Acute AION occurred at least 6 weeks before testing. Results. After adjustment for degree of injury according to either MD or mean NFL thickness, all HRT parameters were significantly different between OAG and both NAION and AAION. With similar damage, OAG eyes had larger, deeper cups; smaller rims; more cup volume; and less rim volume (all P < or = 0.001). There were differences in disc topography between NAION and AAION, but they were not consistent for both measures of damage. Disc area and MD were also significantly associated with many HRT parameters. NFL thickness was greater at the same MD for both AAION and NAION compared with OAG. Conclusions. NAION and AAION cause loss of RGCs, but have significantly different disc topography compared with OAG at a given level of RGC loss.
Investigative ophthalmology & visual science 09/2009; 51(4):2003-10. · 3.43 Impact Factor
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ABSTRACT: Orbital decompression for dysthyroid orbitopathy may be performed by open or transnasal endoscopic approaches; however, criteria for the selection of the appropriate surgical technique have not been well-defined. Our goal was to compare the surgical outcomes of orbital decompression techniques employed by the otolaryngology and ophthalmology services at a single institution, so as to clarify the indications and develop a rationale for optimal management.
Case series with chart review.
Tertiary care academic medical center.
Orbital decompressions on 112 orbits of 69 patients from 2001 to 2008 at a tertiary care academic medical center.
The majority (83%) of orbital decompressions were performed primarily for proptosis, whereas the remainder was indicated for dysthyroid optic neuropathy. Maximum reduction of proptosis was achieved with an endoscopic medial and inferior orbital wall decompression combined with a lateral orbitotomy with fat removal. The average reduction in proptosis was 7.4 mm+/-2.3 mm (primary surgery for proptosis). The endoscopic approach alone provided the least average proptosis reduction but was highly successful in the treatment of dysthyroid optic neuropathy.
A three-wall decompression using a combined endoscopic and external approach provides the greatest amount of decompression. The endoscopic approach as a single modality is best suited for patients with mild proptosis and for patients with dysthyroid optic neuropathy. Cooperation between otolaryngology and ophthalmology achieves the best care for patients with thyroid eye disease who require surgical treatment.
Otolaryngology Head and Neck Surgery 08/2009; 141(1):39-45. · 1.72 Impact Factor
