A new gene mutation in a family with idiopathic infantile nystagmus

Idiopathic infantile nystagmus (IIN) is an inherited disease, which can occur through a number of different inheritance patterns (autosomal dominant, recessive, or X-linked). The most common of these is X-linked inheritance with incomplete penetrance and variable expressivity, and can also be dominant or recessive. To date, only two mutations have been described: the first, affecting the FPR143 gene, which is associated with ocular albinism type I, and located on chromosome Xp22, and the second, affecting the FRMD7 gene located on chromosome X26-q27. To date, a causative gene on locus Xp11.3p11.4 has not yet been identified. The most common cause of IIN is due to mutations in the FRMD7 gene, located on chromosome Xq26. We present a case of a new mutation found in three siblings from a family with FRMD7-related infantile nystagmus, whose parents are consanguineously related in the first degree. A complex mutation has occurred in this family, which, to date, has not been previously reported in the scientific literature. The complex mutation consists of the presence of three consecutive 1 bp deletions in exon 12 (c.1248delT; 1299del C; and 1312delT), causing a secondary deletion (c. 1340–2145 + 214del), and resulting in a truncated protein. We also present a 7-year-old patient from a different family, with periodic alternating nystagmus, having no mutation in the FRMD7 gene, which we assume may be an example of non-FRMD7-related IIN. This patient does not have a family history of nystagmus.

CHARGE syndrome: A case report of two new CDH7 gene mutations

CHARGE syndrome is a genetic disorder comprising the following clinical features: coloboma, heart defects, choanal atresia, retardation (of growth and development), as well as genitourinary and ear abnormalities. This syndrome is caused by mutations in the CDH7 gene, located on chromosome 8 (8q12). We present two new gene mutations in two patients with CHARGE syndrome, not previously reported in the scientific literature. Both of these patients clearly demonstrate the difference in the clinical expression of this syndrome, with patient 1 having a greater clinical severity compared to patient 2. We conclude that although in the scientific literature to date there is no clear correlation between a patient's genotype and phenotype expression, we can assume from the cases we present that a correlation does in fact exist. Specifically, missense mutations (as in case of patient 2) are associated with milder clinical expression, whereas mutations which result in truncation of the CDH7 protein (as in the case of patient 1 having a nonsense mutation) may be associated with a more severe clinical expression.

Topical mitomycin in endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in older children

PURPOSE

Mitomycin C has been used in ophthalmic surgery to mitigate postoperative scarring. However, the outcomes of endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction with adjunctive mitomycin C in children remain unknown. Our study was aimed to evaluate the efficacy and safety of adjunctive application of mitomycin C after endoscopic-assisted probing for the treatment of congenital nasolacrimal duct obstruction in children.

METHODS

This is a retrospective chart review performed in a tertiary eye care hospital involving children with congenital nasolacrimal duct obstruction, who underwent endoscopic-assisted probing from October 2013 to August 2015. We compared children who underwent endoscopic-assisted probing with mitomycin C (mitomycin C group) versus others who underwent endoscopic-assisted probing without mitomycin C (endoscopic-assisted probing group). The mitomycin C group received 0.2 mg/ml within 4 min to the nasolacrimal duct ostium using a cotton tip applicator immediately after probing. Probing was considered successful when patient complaints of tearing were reduced or the results of the dye disappearance test were normal. Demographic data, clinical features, and intraoperative and postoperative variables were correlated to the success rate.

RESULTS

The study sample comprised 68 lacrimal vies. The majority of children had bilateral obstruction and no previous history of probing. The mean age of the patients was approximately 4 years. Most obstructions were considered complex. The success rates were high in both groups (p>0.05). There were no adverse events related to the use of mitomycin C (p>0.05).

CONCLUSIONS

Although mitomycin C has no adverse effects when applied to the opening of the nasolacrimal duct, its use after lacrimal probing for the treatment of congenital nasolacrimal duct obstruction does not improve the chance of success.

Punctal Plug as a Treatment Option for Dry Eye Associated with Congenital Supernumary Puncta

This study aims to describe a case of double lower lacrimal punctum-canaliculi in a dry eye patient treated with a punctal plug. A 60-year-old healthy female presented with complaints of tearing, itchy eyes, and foreign body sensation in the right eye for many years. There was no history of trauma or inflammation. Two patent independent supernumerary puncta and canaliculi were present on the right lower eyelid. The Schirmer Test II (with anesthesia) was zero, the tear breakup time was 2 s, and superficial punctate erosions were present in the right eye. A long-term nonabsorbable punctal plug was inserted into one of the lower puncta. At 9-month follow-up, the dry eye symptoms decreased markedly, the Schirmer Test II improved and superficial keratitis resolved.

Tungiasis infestation of dermis fat graft in an anophthalmic socket

A patient with an anophthalmic socket with a dermis-fat graft (DFG) developed inflammation and a foul odour in the right socket. The DFG was surgically removed and Tungiasis infestation was detected. This is the first case to report Tungiasis infestation in a DFG in an anophthalmic socket.

A clinical case of Zellweger syndrome in a patient with a previous history of ocular medulloepithelioma

Peroxisomal biogenesis disorders (PBDs) are autosomal recessive diseases caused by mutations in one of the 14 PEX genes described in the scientific literature.

All of these syndromes may be associated with different mutations in the PEX genes, the most frequent being PEX1 for patients with Zellweger syndrome (ZS).

In this paper, we present the case of a patient with a peculiar clinical history: evisceration of the left eye (LE) at 4 years of age because of a benign ocular teratoid medulloepithelioma and a progressive loss of visual acuity (VA) in the right eye (RE) beginning at 9 years of age, leading to the diagnosis of ZS. In addition, the patient presented a mutation in the PEX14 gene that has not been previously described in the literature.

This case broadens the spectrum of clinical expression in ZS patients because of not only the presence of a benign ocular teratoid medulloepithelioma at 4 years of age but also the late clinical expression of ZS (at 9 years of age).

Clinical presentation of multiple cerebral emboli and central retinal artery occlusion (CRAO) as signs of cardiac myxoma

Cardiac myxomas are benign tumors of endocardial origin that usually occur in the left atrium. Trans-thoracic echocardiography is the diagnostic method of choice, and early surgical removal is the preferred method of treatment. We present a patient whose history of cerebral emboli and central retinal artery occlusion (CRAO) led to a diagnosis of cardiac myxoma. Neuroimaging studies showed multiple infarcts in the region of the left middle and anterior cerebral arteries. Ophthalmic examination showed gross retinal pallor compatible with left central retinal artery occlusion (CRAO). The etiology of stroke was investigated by performing trans-thoracic echocardiography, which showed a mass in the left atrium compatible with cardiac myxoma. Complete removal of the cardiac tumor was performed by open-heart surgery. Fortunately, after a period of rehabilitation, the patient's hemiparesis almost completely resolved, but the loss of vision OS remained unchanged. Many cases of myxoma are accompanied by constitutional symptoms, such as anemia, fever and weight loss, which allow for a diagnosis to made before serious complications such as embolism occur. Unfortunately, in some patients, such as ours, the absence of signs and symptoms allows the myxoma to pass completely unnoticed until the first embolic event occurs.

Chronic Orbital Inflammation Associated to Hydroxyapatite Implants in Anophthalmic Sockets

Purpose

We report 6 patients who received a hydroxyapatite (HA) orbital implant in the socket and developed chronic orbital inflammation unresponsive to conventional medical therapy.

Case Reports

We assisted 6 cases (4 males, 2 females) who received an HA orbital implant in the socket between 2015 and 2016 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and developed chronic orbital inflammation with chronic discharge, redness, and pain (onset from weeks to over 2 decades after surgery). Computed tomography evaluation indicated inflammation in the orbital tissues, and histological examination showed a foreign body granulomatous reaction mainly localized around and blanching the HA implant. The condition was unresponsive to usual medical treatment and was resolved immediately after implant removal.

Conclusions

Chronic inflammation can occur decades after placement of an HA implant in the orbit and can be successfully treated with implant removal.

Dacryocystectomy: Indications and Results at Tertiary Eye Hospital in Central Saudi Arabia

PURPOSE

To report indications and success rates of dacryocystectomy (DCT) in a tertiary hospital.

METHODS

A retrospective chart review was performed of all patients who underwent DCT at the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2008 to 2015. Data included patient demographics, symptoms before and after surgery, and complications. Univariate analysis using parametric and non-parametric methods was performed.

RESULTS

Forty-seven DCT surgeries were performed over the study period. The median age of patients was 58.2 ± 2 years old, 63.8% were female, 60% of surgeries were performed on the left side, and 8% of patients underwent bilateral simultaneous DCT. Chronic dacryocystitis was the surgical indication for DCT for all of the patients and 23.5% of them had dry eye preoperatively. Successful treatment was observed in 80.8% of patients and 8.5% complained of tearing after DCT.

CONCLUSION

The main indication for DCT in our hospital was chronic dacryocystitis with good outcomes for elderly patients with dry eyes.

Validity of autorefractor based screening method for irregular astigmatism compared to the corneal topography- a cross sectional study

AIM

To present a method of screening for irregular astigmatism with an autorefractor and its determinants compared to corneal topography.

METHODS

This cross-sectional validity study was conducted in 2013 at an eye hospital in Spain. A tabletop autorefractor (test 1) was used to measure the refractive status of the anterior surface of the cornea at two corneal meridians of each eye. Then corneal topography (test 2) and Bogan's classification was used to group eyes into those with regular or no astigmatism (GRI) and irregular astigmatism (GRII). Test 1 provided a single absolute value for the greatest cylinder difference (Vr). The receiver operating characteristic (ROC) were plotted for the Vr values measured by test 1 for GRI and GRII eyes. On the basis a Vr value of 1.25 D as cut off, sensitivity, specificity were also calculated.

RESULTS

The study sample was comprised of 260 eyes (135 patients). The prevalence of irregular astigmatism was 42% [95% confidence interval (CI): 36, 48]. Based on test 2, there were 151 eyes in GRI and 109 eyes in GRII. The median Vr was 0.75 D (25% quartile, 0.5 D) for GRI and 1.75 D (25% quartile, 1.25 D) for GRII. The area under curve was 0.171 for GRI and 0.83 for GRII. The sensitivity of test I was 78.1% and the specificity was 76.1%.

CONCLUSION

A conventional autorefractor can be effective as a first level screening method to detect irregular corneal astigmatism in places where corneal topography facilities are not available.

Genetic Testing for Wolfram Syndrome Mutations in a Sample of 71 Patients with Hereditary Optic Neuropathy and Negative Genetic Test Results for OPA1/OPA3/LHON

In this study, the authors present a sample of 71 patients with hereditary optic neuropathy and negative genetic test results for OPA1/OPA3/LHON. All of these patients later underwent genetic testing to rule out WFS. As a result, 53 patients (74.7%) were negative and 18 patients (25.3%) were positive for some type of mutation or variation in the WFS gene. The authors believe that this study is interesting because it shows that a sizeable percentage (25.3%) of patients with hereditary optic 25 neuropathy and negative genetic test results for OPA1/OPA3/LHON had WFS mutations or variants.

Congenital distichiasis: Histopathological report of 3 cases

Distichiasis is a condition clinically presenting as partial or complete accessory row of lashes that emerges from the meibomian glands orifices. It can be an acquired or congenital with an autosomal dominant inheritance. The histopathological features are not well described in the ophthalmic literature, however they include abnormal pilosebaceous units within the posterior lamella of the eyelid and perifollicular chronic inflammatory cell infiltration. In this report, we describe the histopathological findings of three congenital distichiasis cases treated at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia with discussion on the pathogenesis of such a condition and the differentiating features from ectopic cilia.

Three New PAX2 Gene Mutations in Patients with Papillorenal Syndrome

Papillorenal syndrome (PAPRS; Mendelian Inheritance in Man [MIM] 120330) is an autosomal dominant disease characterised by the presence of congenital renal and optic nerve abnormalities associated with mutations of the PAX2 gene. In this article, the authors present four patients with PAPRS who are carriers of three new PAX2 mutations, as well as another patient with a possible non-pathogenic variant of the PAX2 gene. All patients were given a full neurophthalmological examination, and all patients underwent a genetic test for PAX2. Patients 1 and 2 presented with the classic signs of PAPRS: renal disease associated with a congenitally abnormal optic disc, whereas patients 3 and 4 only presented with a congenital optic nerve abnormality and no renal involvement. In patients 1 and 2, the optic nerves were affected by the presence of a central excavation within the optic disc, absence of the central retinal artery, as well as multiple cilioretinal arteries radiating from the periphery of the optic disc. Bilateral optic nerve pits were seen in patient 3, and lastly, in patient 4 there was the presence of superficial gliotic tissue on the left optic disc. All patients presented with a missense mutation in the PAX2 gene, where in patient 4 possibly being only a non-pathogenic variant of the gene. In conclusion, the authors present two patients with classic clinical signs of PAPRS, having two new PAX2 mutations, which until now have not been described in the current literature; another patient with a new PAX2 mutation showing only ocular manifestations of the disease, and lastly, a patient who is a carrier of a variant of the PAX2 gene has a congenitally abnormal optic disc, which is probably not related to PAPRS.

Accidental lacrimal gland removal during resection of the levator palpebrae superioris muscle

Accidental removal of the lacrimal gland is a rare complication of ptosis surgery. We report two children who underwent large unilateral levator palpebrae superioris resections (LPSr). After surgery, both patients developed dry eye. Post-operatively, the parents of both patients noticed no tears in the affected eye when their child cried. Computed tomography proved the absence of the lacrimal gland in the operated eye in both patients. Oculoplastic surgeons should pay close attention to the anatomy of the levator muscle and its proximity to surrounding tissues in order to avoid lesions on important orbital structures, including the lacrimal gland, and to avoid the development of long-term dry eye.

Outcomes of Two Surgical Techniques Using Silicone Rod for Frontalis Sling Suspension to Treat Severe Ptosis

PURPOSE

To compare outcomes of two techniques of frontalis silicone sling surgery.

METHODS

This retrospective, nonrandomized chart review was performed on patients undergoing frontalis sling surgery between 2008 and 2011. Silicone rods were sutured to the tarsal plate through an eyelid crease incision (open method) or stab incisions (closed method). Data were collected on age, gender, type of surgery, preoperative and postoperative margin reflex distance (MRD), and complications. A successful outcome was defined as a postoperative score of 2 to 4 for MRD or an improvement in MRD.

RESULTS

A total of 155 eyelids of 146 patients with ptosis were included. There were 60 patients in the open method group and 85 patients in the closed method group, respectively. Successful outcomes were seen in 30 (50%) patients in the open method and 44 (51.8%) patients in the closed method groups. There were 61 (71.8%) patients in the open method group and 45 (75%) patients in the closed method group who had improved MRD at last follow-up. The main complications were exposure keratitis, eyelash ptosis, and eyelid crease abnormalities that occurred only in the closed method group.

CONCLUSIONS

The silicone frontalis sling procedure had the same success rates in both the open and closed methods. Eyelash and eyelid crease abnormalities were unique to the closed method. [J Pediatr Ophthalmol Strabismus. 2017;54(1):52-58.].

Visual and neurologic sequelae of methanol poisoning in Saudi Arabia

Objectives:

To present the visual sequelae of methanol poisoning and to emphasize the characteristics of methanol exposure in the Kingdom of Saudi Arabia (KSA).

Methods:

A retrospective case series was carried out on 50 sequential patients with methanol poisoning seen at the King Khaled Eye Specialist Hospital and King Saud University Hospitals in Riyadh, KSA between 2008 and 2014. All patients were examined by a neuro-ophthalmologist at least one month after methanol intoxication.

Results:

All 50 patients were young or middle-aged males. All admitted to drinking unbranded alcohol within 2-3 days before profound or relatively profound, painless, bilateral visual loss. Mean visual acuity in this group was hand motions (logMAR 2.82; range 0.1 - 5.0) with some eye to eye variability within individuals. Worse visual acuity was correlated with advancing age (Pearson correlation: oculus dextrus [right eye] - 0.37, p=0.008; oculus sinister [left eye] - 0.36, p=0.011). All patients had optic atrophy bilaterally, and all tested patients had visual field defects. Tremors with or without rigidity were present in 12 patients, and 11 of 30 patients who had neuroimaging performed had evidence of putaminal necrosis.

Conclusion:

Methanol intoxication causes visual loss within 12-48 hours due to relatively severe, painless, bilateral optic nerve damage that may be somewhat variable between eyes, and is generally worse with advancing age. The coincidence of bilateral optic nerve damage and bilateral putaminal necrosis in a young or middle-aged male is very suspicious for methanol-induced damage.

Success Rates of Conventional Versus Endoscope-Assisted Probing for Congenital Nasolacrimal Duct Obstruction in Children 12 Years and Younger

PURPOSE

To compare the success rates for congenital nasolacrimal duct obstruction (CNLDO) treated with conventional probing versus endoscope-assisted probing.

METHODS

A retrospective nonrandomized comparison of the success rates in children (0 to 12 years) with CNLDO who underwent conventional probing or endoscope-assisted probing. Success was defined as absence of tearing or negative fluorescein dye disappearance test. Stent was evaluated.

RESULTS

A total of 270 patients with CNLDO comprised the study population. The mean age was 37 months in the conventional probing group and 48.5 months in the endoscope-assisted probing group. The subjective and objective success rates were 76.1% and 75.9%, respectively, in the conventional probing group and 95.7% and 95.7%, respectively, in the endoscope-assisted probing group. The success rates were higher for both methods in the endoscope-assisted probing group (P < .005). The success rate decreased in older children in the conventional probing group (100% < 6 months; 62.5% > 48 months) and remained stable in the endoscope-assisted probing group (100% < 6 months; 97% > 48 months). Stent did not improve success.

CONCLUSIONS

Endoscope-assisted probing increased success in older children and children with bilateral obstruction. [J Pediatr Ophthalmol Strabismus. 2016;53(5):292-299.].

A steep peripheral ring in irregular cornea topography, real or an instrument error?

Purpose

To demonstrate that the steep peripheral ring (red zone) on corneal topography after myopic laser in situ keratomileusis (LASIK) could possibly due to instrument error and not always to a real increase in corneal curvature.

Methods

A spherical model for the corneal surface and modifying topography software was used to analyze the cause of an error due to instrument design. This study involved modification of the software of a commercially available topographer.

Results

A small modification of the topography image results in a red zone on the corneal topography color map.

Conclusion

Corneal modeling indicates that the red zone could be an artifact due to an instrument-induced error. The steep curvature changes after LASIK, signified by the red zone, could be also an error due to the plotting algorithms of the corneal topographer, besides a steep curvature change.

Clinical variability in hereditary optic neuropathies: Two novel mutations in two patients with dominant optic atrophy and Wolfram syndrome

Dominant optic atrophy (DOA) and Wolfram syndrome share a great deal of clinical variability, including an association with hearing loss and the presence of optic atrophy at similar ages. The objective of this paper was to discuss the phenotypic variability of these syndromes with respect to the presentation of two clinical cases.

We present two patients, each with either DOA or Wolfram syndrome, and contribute to the research literature through our findings of two novel mutations.

The overlapping of several clinical characteristics in hereditary optic neuropathies can complicate the differential diagnosis. Future studies are needed to better determine the genotype-phenotype correlation for these diseases.

Accessory lacrimal gland duct cyst: 23 years of experience in the Saudi population

BACKGROUND AND OBJECTIVES

Accessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions.

DESIGN AND SETTING

Retrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991-2014).

PATIENTS AND METHODS

Data on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist.

RESULTS

Of 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months.

CONCLUSION

The approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.

Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

Purpose:

The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET).

Methods:

The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis.

Results:

Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze.

Discussion:

Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET.

Macular star formation in diabetic patients with non-arteritic anterior ischemic optic neuropathy (NA-AION)

BACKGROUND

NA-AION is a condition that exhibits a number of unique characteristics in diabetics compared with the rest of the population. In some diabetic patients with NA-AION, lipid deposits can be observed around the macula forming an incomplete macular star.

METHODS

We describe 12 case studies of patients with NA-AION observing the development of lipid deposits around the macula forming an incomplete macular star.

RESULTS

All our patients developed some level of lipid deposits around the macula in the form of a macular hemistar in the course of their illness.

CONCLUSION

Some authors have suggested that the macular star is formed by transudation from capillaries deep in the optic disk through the intermediary tissue of Kuhnt, which is located between the retina and the anterior portion of the lamina retinalis. However, the development of the macular star is currently understood not as a simple transudation but as a multifactorial process involving the presence of vascular damage around the optic disk, which is considered one of the most important factors leading to its occurrence. Although some studies mention the presence of a macular star in patients with NA-AION, we believe that this phenomenon may be significantly more common than the current literature suggests.

Unusual presentation of a multiple sclerosis case involving central retinal artery occlusion

The term intermediate uveitis (IU) refers to a subgroup of uveitis in which the vitreous is the site of greatest inflammation. Patients with multiple sclerosis (MS) have a greater frequency of IU compared with the general population.

The IU associated with MS is characterized by the presence of pars planitis (occasionally accompanied by anterior uveitis) and the presence of peripheral retinal vasculitis in the form of periphlebitis (venous sheathing) in 6–26% of patients.

We present a patient with an unusual initial presentation of MS involving central retinal artery occlusion (CRAO) in the right eye (RE).

Although retinal vascular changes are asymptomatic in the majority of MS patients, the spectrum of impairment ranges from simple peripheral retina periphlebitis to the presence of peripheral occlusive retinal vasculitis in 6.5% of patients.

This atypical case may represent an extreme of the spectrum of retinal vasculitis associated with demyelinating disease.

Cupping of the optic disk after methanol poisoning

PURPOSE

To assess the frequency and significance of optic disk cupping after methanol poisoning.

METHODS

We retrospectively reviewed the medical records of 50 consecutive patients with methanol poisoning, including visual acuity, pupillary reaction, and optic disk features such as the presence and degree of cupping. All patients were examined in the chronic phase after optic nerve damage.

RESULTS

Optic disk cupping ≥0.8 c/d was present in at least one eye of 22 of these 50 patients (43/100 eyes). Severity of cupping was statistically symmetric in the two eyes, and increasing severity of cupping was correlated with worse visual acuity (p=0.007) and increasing visual field loss. Degree of cupping was significantly correlated with increasing patient age but not with putaminal necrosis.

CONCLUSIONS

Optic disk cupping after methanol poisoning may be more common than previously recognised. Cupping in this setting may reflect toxicity of methanol metabolites to axons and glial cells in the prelaminar, laminar and retrolaminar regions, and seems to be important as a marker for worse optic nerve damage.

Papilledema and optic disc pit: The association of two pathologies in one patient

Histologically, optic disc pit (ODP) is described as a small congenital defect in the cribriform plate where a herniation of the dysplastic retina extends to the subarachnoid space in the optic nerve, which is surrounded by a layer of collagen-rich tissue. Approximately 25-75% of cases are complicated by optic disc pit maculopathy (ODPM). The pathogenesis of maculopathies associated with ODP has not been fully elucidated. We present an unusual case of a patient with a history of papilledema secondary to a fronto-temporal meningioma. The patient underwent a successful surgical intervention with resolution of the papilledema 15 years before the detection of an ODP that was associated with retinal detachment in the macular region. Several studies have reported on the importance of intracranial pressure in the development of maculopathies associated with ODP. During the period of intracranial hypertension and papilledema in our patient, the hernia sac that was associated with ODP may have been small, which would have decreased the chances of developing a maculopathy that was associated with OPD.

Sequential, non-arteritic anterior ischemic optic neuropathy in patients taking sildenafil: a report of ten cases

AIM/PURPOSE

To present a summary of 10 cases of non-arteritic anterior ischemic optic neuropathy (NAION) in patients who received phosphodiesterase type 5 (PDE-5) inhibitors.

METHODS

A case series of 10 patients who, after regular intake of Sildenafil, presented with a first episode of NAION in one eye. NAION was diagnosed based on the following criteria: acute, painless, unilateral loss of vision, fundus features consistent with NAION and exclusion of other possible causes.

RESULTS

Despite the initial adverse event (first episode of NAION), all of these patients continued to use the medication and developed a second episode of NAION in the contralateral eye. Only one of the 10 patients presented with bilateral simultaneous NAION.

CONCLUSION

This largest case series published to date, reinforces the general consensus that PDE-5 inhibitors are contraindicated in patients with a history of unilateral NAION.