Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Autoantibodies to the acetylcholine receptor or, less frequently, to muscle-specific kinase, attack against the postsynaptic junctional proteins, resulting in fluctuating and variable weakness of muscles. Extraocular, levator palpebrae superioris, and orbicularis oculi muscles are particularly susceptible. The majority of patients with MG present with purely ocular symptoms including ptosis and diplopia initially. About half of these patients progress to generalized disease within 2 years. The prevalence of MG in Taiwan is 140 per million with male to female ratio of 0.7. The incidence rate is higher in the elderly. Several immune-related diseases such as lymphoid malignancy, diabetes, and thyroid diseases are associated with MG in the national population-based studies in Taiwan. Ice pack test, rest test, Tensilon/neostigmine test, circulating antibody measurement, and electrophysiological studies are useful diagnostic tools with variable sensitivity and specificity. For the patients with ocular MG, acetylcholinesterase inhibitors are usually the first-line treatment. Corticosteroids and immunosuppressant could provide better disease control and may reduce the risk of conversion to generalized form although there is still some controversy. A thymectomy is also beneficial for ocular MG, especially in refractory cases. The correction of ptosis and strabismus surgery could improve the visual outcome but should be performed only in stable disease.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

Neovascular glaucoma (NVG), which is refractory to both medical management and surgical intervention, is a disastrous ocular disease for it always ends up with intolerable pain and extinguishing patients' residual visual function. Since insufficient acknowledge of the pathophysiological and molecular mechanisms of NVG, it has been laying a challenging dilemma of managing NVG in clinical practice for a long time. Along with the progression on some new agents and surgical options targeting certain possible roles in the NVG process, there seems having been some new sights but still much unknown and to be revealed. This review discusses the underlying etiologic diseases of NVG, molecular findings and characteristics of its pathogenic process, as well as the management of NVG in detail. In addition, here represents some of our hypothesis regarding the interesting findings about NVG in clinical practice, aiming to provide some new enlightenment for future research.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

PURPOSE: The purpose of this research is to evaluate the relationship between of optic atrophy 1 (OPA1) polymorphism and normal tension glaucoma (NTG) by surveying patients from central Taiwan. This study finding could help us to understand the impact of OPA1 polymorphism on glaucoma. METHODS: We try to identify the effect of OPA1 polymorphism by comparing the clinical presentation in three catalogs of gene polymorphism in patients with NTG. Our research team includes patients with NTG from central Taiwan and assesses the OPA1 intervening sequence 8 (IVS8) + 4 C->T and IVS8 + 32 T->C polymorphism. We divide these patients into three OPA1 IVS8 + 4 subgroups, CC, CT, TT, and three IVS8 + 32 subgroups, TT, TC, CC. By collecting their ocular clinical data, systemic background, and other possible factors related to the presentation of glaucoma, we can compare these characters of each polymorphism subgroup. RESULTS: We find that all patients do not have OPA1 IVS8 + 4 C->T polymorphism while some of them do have IVS8 + 32 T->C polymorphism. NTG with OPA1 IVS8 + 32 T->C polymorphism inclines to have more nasal-step type visual field defect (P = 0.016) and inferior nerve fiber layer thickness loss (P = 0.098) in comparison to NTG with IVS8 + 32 wild type. CONCLUSIONS: The OPA1 IVS8 + 32 T->C polymorphism partake to the phenotype and prognosis of NTG in central Taiwan. Even though our findings are far from clear enough to serve as guides for the differentiation of NTG etiologies, they still give us a glimpse of the impact of OPA1 in chronic optic neuropathy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

INTRODUCTION: A comparison of precision of intraocular implant power calculation by computing keratometry values by two different methods, namely, the automated and manual keratometry (MK), was done. For checking this accuracy, the parameter taken into consideration was the absolute refractive error which was ascertained postoperatively. SUBJECTS AND METHODS: This study was conducted in the Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore. At a tertiary eye care centre in Central India (Sri Aurobindo Institute of Medical Sciences, Indore). Duration of the study was 18 months. Sample size was 66 individuals who were with cataract (nuclear sclerosis I to III). Although keratometry was done by both methods and implant power derived separately by computing both readings, decision of which power to be implanted in an eye would depend on the group, in which patient would fall. Group A were prospective candidates who would be implanted intraocular lens (IOL) of that power as assessed by computing MK value, whereas Group B were participants who would be implanted IOL of that power as assessed by computing value obtained by automated keratometry (AK). First patient fell in Group A and second in Group B, third again in Group A till 33 patients had been operated in each group. RESULTS: Bland–Altman plot thus obtained showed that the two keratometers are comparable. The postoperative refractive errors for the two Groups (A and B), showed that if an error of ±0.50 D or less is considered, then in Group A 81% of patients achieved this and 87% of patients required this as spectacle aid in Group B. CONCLUSIONS: In this study, we compared the accuracy of AK with that of MK for calculation of implant power. It was concluded from this study that AK is a simple keratometric technique that appeared to be more accurate than MK.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Posterior reversible encephalopathy syndrome (PRES) is a clinical condition that can cause different ophthalmological and neurological symptoms. Preeclampsia toxemia or eclampsia is one of the leading causes of PRES. Herein, we present a study of a 35-year old woman who gave birth to healthy twins at 35 weeks of gestation by cesarean section because of threatened preterm delivery. On the 1^st postoperative day, the woman developed a severe headache, arterial hypertension, tachycardia, generalized tonic–clonic seizures, and loss of consciousness that persisted for about 2 min. A provisional diagnosis of eclampsia was made, and the woman was then quickly transferred to the intensive care unit where she was treated with antihypertensive therapy, magnesium sulphate, and diazepam. Following stabilization of the general condition, the patient noticed sudden bilateral blindness. An ophthalmological examination revealed significant bilateral loss of vision at the level of insecured light perception, normal pupillary responses to a light stimulus, and normal fundus findings. On this basis, an ophthalmologist made the diagnosis to cortical blindness. Radiographic analysis showed an edematous change in the occipital and parietal brain regions, thus suggesting a diagnosis of PRES. In conclusion, cortical blindness is a clinically striking ophthalmic disorder that may occur in PRES associated with postpartum eclampsia.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

PURPOSE: Thromboembolic phenomenon is one of the causes of retinal vein occlusion (RVO) which is in fact a multifactorial disease. Therefore, we aimed to study methylenetetrahydrofolate reductase gene polymorphism (MTHFR C677T) and factor V Leiden as genetic risk factors of RVO. MATERIALS AND METHODS: A total of 50 (19 males and 31 females) cases of RVO were compared with 50 age- and sex-matched (21 males and 29 females) controls. Complete ocular examination was done for all samples. The diagnosis of RVO was made clinically; however, fundus fluorescein angiography and optical coherence tomography were performed when needed. Serum homocysteine levels were estimated by automatic chemiluminescence analyzer, whereas MTHFR C677T and factor V Leiden mutations were detected by polymerase chain reaction–restriction fragment length polymorphism method. RESULTS: The mean age of RVO cases and controls was 54.62 ± 13.92 years and 58.72 ± 11.20 years, respectively. 48.3% of cases and 51.7% of controls were diabetic. 65.3% of cases were hypertensive proving hypertension as a strong risk factor (P = 0.003) of RVO. Serum homocysteine was also found significantly high (P = 0.025) with mean values of 19.98 ± 9.03 μmol/L and 16.98 ± 8.29 μmol/L in cases and controls, respectively. The MTHFR genotype (CT) was found in 83.3% patients of central RVO group and 78.6% cases of branch RVO group that was significantly associated with high serum homocysteine levels. Factor V Leiden mutation was absent in all individuals. CONCLUSION: Hyperhomocysteinemia is an important risk factor for RVO, especially in patients with MTHFR C677T gene polymorphism.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

CONTEXT: Cataract is the most common cause of blindness worldwide. Meeting World Health Organization Vision 2020 cataract surgical rate target for Africa remains a dream. Inadequate resource to deliver quality cataract services is burdensome. AIMS: The aim of the study was to evaluate the resource for cataract services in Kebbi, Nigeria. SETTINGS AND DESIGN: A descriptive and analytic cross-sectional study using a quantitative questionnaire. SUBJECTS AND METHODS: Four-year-period (2012–2015) information on, among others, available resources for cataract services was obtained from all the hospitals offering cataract surgical services in Kebbi. STATISTICAL ANALYSIS USED: The data were double entered into Excel spread sheet and later exported onto and analyzed by STATA 14. The analysis was done using simple frequency proportions and is presented as tables, charts, and graphs. RESULTS: Only 71 eye care workers were involved in the delivery of eye care services including cataract service in Kebbi with over 4 million people. The equipment required for effective services delivery was at the minimum. CONCLUSIONS: There were inadequate, poorly mixed, and lopsided resources for cataract services delivery in Kebbi. The need to improving resource for quality cataract service delivery in Kebbi toward meeting Vision 2020 target underscored.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

We report a case presenting with bilateral oculomotor nerve palsy (ONP) resulting from a midbrain hemorrhage. The patient visited the ophthalmological clinic due to the sudden onset of horizontal diplopia for a week. Bilateral ONP spared the left eye levator and bilateral pupils were found while the remaining results of examinations were unremarkable. Cerebral magnetic resonance imaging revealed a midbrain hemorrhage. Mono-ocular occlusion was arranged, and the patient was referred to a neurologist for further management. No further ophthalmic signs developed, but the patient became bedridden due to brainstem hemorrhage and died of aspiration pneumonia 9 months after the onset of the oculomotor signs. It is advocated that midbrain hemorrhage should be included in the differential diagnosis once diplopia develops and that careful neurological investigation of the origin of diplopia is warranted.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

We presented a rare case of a sole choroidal metastatic tumor from esophageal squamous cell carcinoma (ESCC) without other organ metastasis in Taiwan. A 43-year-old male with ESCC was referred for a 1-month history of decreased vision in his left eye. A 5.7 mm thick, yellow choroidal tumor occupied posterior pole, featured with pinpoint hyperfluorescence on angiography and subretinal fluid on optical coherence tomography. Positron emission tomography showed a singular hypermetabolic focus in the left eye. The tumor regressed with complete response and the vision preserved after radiation with total 57.60 gray applied by tomotherapy. The gastrointestinal system is the third most common metastatic origin in Taiwan while esophageal cancer metastasizing to choroid is rare. The discrepancy between the high prevalence of primary ESCC and the rareness of choroidal metastasis from ESCC is undetermined.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]