American journal of ophthalmology
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We examined six patients who developed blurring or oscillopsia as a result of downbeat nystagmus while being treated with lithium carbonate. Of these six plus six previously described similar patients, all but two developed downbeat nystagmus insidiously as an isolated disorder in the setting of otherwise satisfactory therapeutic control, without clinical or biochemical evidence of acute lithium intoxication. Only six of these 12 patients were able either to reduce or to stop taking lithium, and in only two of these six did the downbeat nystagmus improve or remit.
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We examined two patients with acute orbital myositis associated with orbital hemorrhage and eyelid ecchymosis. Both patients were young women (aged 22 and 30 years) who had painful proptosis, diplopia, and computed tomographic evidence of single extraocular muscle involvement with spillover of inflammatory edema into the adjacent orbital fat. ⋯ Both patients were treated successfully with high-dose systemic corticosteroids. Some cases of idiopathic orbital inflammation may be related to preexisting vascular anomalies or orbital phlebitis.
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The ocular effects of cardiopulmonary bypass surgery were prospectively studied in 46 patients. We examined preoperative and post-operative visual acuity, intraocular pressure, body weight, fluids infused during surgery, hematocrit, and cardiopulmonary bypass time. On the first postoperative day mean intraocular pressure increased 2.1 mm Hg (P = .003) from baseline preoperative levels. ⋯ The increase in intraocular pressure did not correlate with the postoperative weight gain or hemodilution. However, the medications necessary after cardiac surgery may be a significant confounding variable. This study demonstrates that one cause of ocular problems from cardiopulmonary bypass surgery may be related to the dynamics of intraocular pressure.
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We studied the clinical and pathologic features of a traumatically ruptured eye seven years after radial keratotomy. The radial keratotomy incisions were identified and topographically related to perforation sites. Three radial keratotomy incisions were perforated. ⋯ Radial keratotomy incision depths ranged from 50% to 90% in the remaining incisions. All incisions showed disruption of Bowman's membrane, 15 of 16 showed malapposition of Bowman's membrane, and 14 of 16 showed epithelial plugging. In this case the healing and strength of radial keratotomy incisions were suboptimal seven years after the procedure.