Seminars in ophthalmology
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Seminars in ophthalmology · Sep 2004
Case ReportsOccipital lobe infarction following cardiac ablation.
A 60-year-old man presented with the chief complaint of seeing a blurred area just up and to the left of the center of his vision. The patient noted this visual field defect immediately after he awoke from a cardiac electrophysiologic study with a catheter ablation procedure. ⋯ MRI showed a small irregular area of abnormal signal in the right occipital lobe consistent with an ischemic lesion. To the best of our knowledge, this represents the first case report of a homonymous visual field defect secondary to an occipital lobe infarction following a cardiac catheter ablation procedure.
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Optic disc drusen are congenital and developmental anomalies of the optic nerve head seen commonly in clinical practice, often as an incidental ophthalmologic finding during routine exams. Optic disc drusen are a form of calcific degeneration in some of the axons of the optic nerve. Visual acuity is often not affected but the visual fields of these patients can be abnormal and deteriorate over time. ⋯ The diagnosis can be made with clinical findings combined with B scan ultrasound and computed tomography. In addition, newer modalities using optic nerve head tomography are proving to be very useful. Since children as well as adults are affected, it is important to consider optic nerve head drusen in the differential diagnosis of papilledema or optic nerve swelling.
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Seminars in ophthalmology · Dec 2003
Case ReportsTopical phenylephrine may result in worsening of visual loss when used to dilate pupils in patients with vaso-occlusive disease of the optic nerve.
Four patients (age range 54-82, 1F 3M) diagnosed with non-arteritic ischemic optic neuropathy experienced acute worsening of visual function after instillation of phenylephrine for dilated funduscopic examination. They experienced decreased visual function immediately or shortly after administration of topical mydriatic drops given in preparation for funduscopy. In all cases one drop each of 2.5% phenylephrine and 0.5-1% tropicamide was used. ⋯ Vasoconstriction of the watershed posterior ciliary capillary beds may result in further precipitating infarction of already compromised circulatory territories in edematous optic nerves. Because phenylephrine is a known vasoconstrictor in vivo and in vitro, it is more likely to cause deleterious vasoconstriction and an acute decline in visual function in patients with acute ischemic optic neuropathy than tropicamide. The routine practice of using phenylephrine to prepare patients for funduscopic assessment should be re-examined, particularly in patients with ischemic optic neuropathy.
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Seminars in ophthalmology · Sep 2003
ReviewCombined pars plana vitrectomy and lens management in complex vitreoretinal disease.
Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. ⋯ Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.
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Seminars in ophthalmology · Sep 1995
ReviewColor Doppler imaging in disorders of the orbit, retina, and optic nerve.
In summary, CDI is being increasingly used in both clinical and research settings to investigate vascular disorders of the orbit, retina, and optic nerve. It is essential for the clinical investigator to be critical and cautious when interpreting the color Doppler flow data, especially when assessing for quantitative orbital hemodynamic changes over serial examinations. Hopefully, application of this technology will continue to provide insight into the pathogenesis of additional ischemic ocular diseases.