RESUMEN
PURPOSE: To evaluate the effect of non-penetrating corneal foreign bodies secondary to explosive blasts on the visual performance of soldiers. METHODS: In a prospective, non-interventional study subjective visual performance and objective optical quality of 11 injured eyes with retained corneal foreign bodies were compared with that of 11 normal controls. Visual performance measures consisted of best spectacle-corrected high-contrast visual acuity (HCVA), low-contrast (5%) visual acuity (LCVA), and contrast sensitivity (CS). LCVA was evaluated in two luminance levels (photopic and mesopic) and two glare conditions (with and without glare). Acuity measurements were scored using logMAR notation. Objective optical quality was assessed comparing total root mean square wavefront error (WFE) and percent higher order aberrations. Modulation transfer functions calculated from the wavefront maps were used to predict the results of the psychophysical contrast testing. RESULTS: HCVA of injured eyes (M = -0.03) did not differ significantly (t(20) = 1.56, p = 0.13) when compared with controls (M = -0.09). However, visual performance of injured eyes (M = 0.33) was significantly worse than control eyes (M = 0.11) on photopic LCVA (t(20) = 4.16, p < 0.001), mesopic LCVA(M = 0.44 vs. M = 0.21, t(20) = 3.85, p = 0.001), mesopic LCVA with glare (M = 0.49 vs. M = 0.21, t(20) = 3.66, p = 0.002), and small letter CS (M = 0.25 vs. M = 0.90, t(20) = -6.6, p < 0.001). For a 6-mm pupil, mean absolute WFE attributed to higher order aberrations for the injured eyes was 0.86 microm and 0.59 microm for the control eyes. This difference was significant (t(20) = -2.15, p = 0.044). CONCLUSIONS: Although HCVA was no different than the normal controls, visual performance of the injured eyes was significantly worse in terms of LCVA and CS. On average, visual performance can be broadly predicted by the modulation transfer function derived from the subjects' wavefront aberration map.
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Traumatismos por Explosión/complicaciones , Córnea , Cuerpos Extraños en el Ojo/etiología , Cuerpos Extraños en el Ojo/fisiopatología , Visión Ocular , Adulto , Anteojos , Femenino , Deslumbramiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Psicofísica , Refracción Ocular , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To report the case of a patient with Fabry disease (FD) whose ocular presentation with chronic chemosis we feel is related to FD and to describe the conjunctival fluorescein angiographic findings. METHODS: A 51-year-old male patient with FD on enzyme replacement therapy presented with 1-month chemosis and mild irritation in the left eye. Ocular examination revealed pronounced noninflammatory chemosis inferotemporally in the left eye with conjunctival tortuosity and microaneurysms bilaterally. There was mild corneal verticillata, spoke-like lens opacities, and retinal vascular tortuosity bilaterally, with no evidence of disc or macular edema. Evaluation revealed no systemic cause for his chemosis, including an orbital computerized tomography scan, which showed clear sinuses and no evidence of an intraorbital mass. RESULTS: Conjunctival fluorescein angiography revealed rapid subconjunctival accumulation of dye in the involved eye but failed to demonstrate leakage from tortuous conjunctival vessels or microaneurysms. CONCLUSIONS: Although the pathology of chronic chemosis in patients with FD is as yet unknown, we believe that FD should be considered in the differential diagnosis of patients presenting with chronic chemosis of unknown etiology.
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Enfermedades de la Conjuntiva/etiología , Edema/etiología , Enfermedad de Fabry/complicaciones , Aneurisma/etiología , Aneurisma/patología , Vasos Sanguíneos/patología , Catarata/etiología , Catarata/patología , Enfermedad Crónica , Conjuntiva/irrigación sanguínea , Enfermedades de la Conjuntiva/diagnóstico , Edema/diagnóstico , Enfermedad de Fabry/tratamiento farmacológico , Enfermedad de Fabry/genética , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Isoenzimas/uso terapéutico , Masculino , Persona de Mediana Edad , Linaje , Vasos Retinianos/patología , alfa-Galactosidasa/uso terapéuticoRESUMEN
We retrospectively reviewed the records of 107 U.S. military personnel referred to the Walter Reed Army Medical Center ophthalmology service with eye diseases and nonbattle injuries diagnosed during Operation Enduring Freedom and Operation Iraqi Freedom. Ocular diseases and nonbattle injuries ranged from minor to vision-threatening, represented a broad variety of conditions, and required the expertise of a number of ophthalmic subspecialists. The most common diagnoses were uveitis (13.1%), retinal detachment (11.2%), infectious keratitis (4.7%), and choroidal neovascularization (4.7%). Eighty-four patients (78.5%) met Army retention standards and were returned to duty. Twenty patients (18.7%) were referred to a medical evaluation board, seven (6.5%) of whom failed to meet retention standards for eye and vision; the retention status of three patients (2.8%) remains to be determined.
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Oftalmopatías/diagnóstico , Lesiones Oculares/diagnóstico , Hospitales Militares/estadística & datos numéricos , Personal Militar/estadística & datos numéricos , Terrorismo , Guerra , Adulto , Estudios Transversales , Demografía , District of Columbia/epidemiología , Oftalmopatías/epidemiología , Lesiones Oculares/epidemiología , Femenino , Humanos , Irak , Masculino , Persona de Mediana Edad , Medicina Militar , Estudios Retrospectivos , Revisión de Utilización de RecursosRESUMEN
A 26-year-old woman displayed a monocular temporal hemianopic defect together with an ipsilateral afferent pupillary defect and bowtie optic nerve hypoplasia. MRI revealed a thin right optic nerve, an asymmetrically thinned chiasm, and an absent septum pellucidum. Monocular temporal visual field loss from organic lesions is quite rare but has been reported in conjunction with compressive lesions at the optic nerve-optic chiasm junction. This is the first report to demonstrate this visual field defect together with bowtie optic nerve hypoplasia.
Asunto(s)
Hemianopsia/complicaciones , Displasia Septo-Óptica/complicaciones , Corteza Visual/patología , Femenino , Lateralidad Funcional , Hemianopsia/patología , Humanos , Corteza Visual/fisiopatologíaRESUMEN
OBJECTIVE: Since the first description of choanal atresia (CA) in 1755, multiple surgical techniques have been proposed to repair the malformation. Today, the transnasal endoscopic method is the most widely accepted repair technique. The bony choanal plates are perforated, the lateral choanae are drilled, and a portion of the vomer removed. Unfortunately, the problem of re-stenosis is a significant issue, and as a result, revision surgery may be a recurring theme in some children. We describe a successful revision endoscopic technique utilizing a microdebrider with straight and 120 degrees telescopes, image guided surgery, and topical mitomycin-C to permanently open the choanae without stenting. METHODS: Described are six children (1-15 years old) with CA or stenosis who have collectively undergone 25 choanal procedures at various institutions. A microdebrider carefully removes the bony septum under direct nasal and intraoral telescopic visualization. No lateral drilling is performed. Image guidance is helpful when excessive scar tissue is present. Topical mitomycin-C minimizes post-operative scarring. The cartilaginous septum is left intact. RESULTS: 2-4-year clinical and endoscopic follow-up on all children revealed a widely patent nasal airway with no complications (epistaxis, crusting, or re-stenosis). Synechiae or re-stenosis did not occur as circumferential mucosal stripping was avoided. No stenting was needed since the bony septum is removed. CONCLUSION: Near total endoscopic removal of the bony septum provides long-term nasal patency for revision CA/stenosis repairs. The endoscopic 'common choanae' technique is aided by transnasal and transoral telescopic visualization with precise microdebrider removal of the bony septum. The technique is safe with no complications in our case series.