American journal of ophthalmology
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Case Reports
Treatment of migraine headache after ocular surgery with intravenous metoclopramide hydrochloride.
To alert ophthalmologists that prolonged or severe postoperative periocular pain and nausea may be caused by migraine. ⋯ Ophthalmologists should consider the diagnosis of postoperative migraine in similar patients and provide specific therapy such as intravenous metoclopramide hydrochloride.
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Case Reports
Cardiopulmonary arrest after retrobulbar anesthesia in a patient with an orbital roof defect.
Cardiopulmonary arrest developed after injection of bupivacaine hydrochloride, lidocaine, and hyaluronidase in a 78-year-old woman who had previously undergone ipsilateral transcranial orbital surgery with removal of the bone of the orbital roof. ⋯ There were several possible mechanisms by which the local anesthetic could have entered the central nervous system. In patients with orbital roof defects, we recommend that retrobulbar anesthetic agents be used with caution.
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We studied a two-generation family with an inherited syndrome of prominent corneal nerves and lesions of the tongue resembling neuromas without the characteristic neoplasms of the multiple endocrine neoplasia type 2B syndrome. Several different point mutations in the RET proto-oncogene on chromosome 10 have been associated with the multiple endocrine neoplasia type 2 syndromes. Molecular genetic studies of families with partial phenotypic expression of these syndromes may aid in further understanding the origin of the variety of clinical manifestations observed in multiple endocrine neoplasia type 2. ⋯ This family demonstrates some of the phenotypic features of the multiple endocrine neoplasia type 2B syndrome without the characteristic neoplasms or the mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B. Their physical findings may be caused by genetic alterations within the RET proto-oncogene on chromosome 10 at yet undetermined sites.
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Case Reports
Rupture of radial and arcuate keratotomy scars by blunt trauma 91 months after incisional keratotomy.
We studied a case in which blunt trauma caused dehiscence of radial and arcuate corneal scars 91 months after incisional keratotomy. The ruptured incisions did not extend beyond the corneoscleral limbus. ⋯ Incisional refractive surgery renders the cornea susceptible to blunt traumatic rupture. This vulnerability results from the intrinsic weakness of the keratotomy wounds. Our case documents that this weakness persists up to 91 months after the operation.
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We examined a pregnant patient who had symptomatic white-centered retinal hemorrhages. Severe preeclampsia rapidly developed despite the patient not having hypertension, proteinuria, or edema at initial examination. ⋯ Retinal hemorrhages gradually resolved without treatment and visual acuity returned to 20/20 six months after emergency delivery of a healthy infant. Retinal or choroidal vascular abnormalities in pregnant patients may be caused by early preeclampsia and immediate obstetric referral is indicated.