To analyze the development and occurrence of the idiopathic intracranial hypertension and consequent visual loss in a family affected with idiopathic intracranial hypertension.
We studied 15 members ...of the same family and found six of them affected with idiopathic intracranial hypertension, which was accompanied with visual loss as a repercussion of the disease. Idiopathic intracranial hypertension was diagnosed on neurological and radiological examination. Visual examination to establish visual loss included fundoscopy, visual acuity, visual field testing, and ultrasonography of the optic nerve.
The construction of a family tree and detailed examination of 15 family members revealed idiopathic intracranial hypertension with visual disturbances, even amaurosis, and different stages of visual field constriction in three members of the family: the mother and her two daughters. Due to the symptoms of idiopathic intracranial hypertension, such as headaches, nausea, vertigo, and the presence of transient visual obscuration and papilledema, in three other members of this family (aged 16, 17, and 25 years), we considered a presumptive diagnosis of idiopathic intracranial hypertension, and the need for thorough follow-up. Medical data on the family grandmother, who died 34 years ago, suggested that she also had symptoms of idiopathic intracranial hypertension. One of the patients underwent surgical treatment by a lumbo-peritoneal shunt operation worsening of the symptoms.
It is very important to include idiopathic intracranial hypertension in differential diagnosis of papilledema and recognize it in early stages to prevent vision loss. Current successful therapeutic approaches and close follow-up of such patients require teamwork of neurologists, ophthalmologists, and neurosurgeons.
The aim of this paper is to compare diameter of healthy and affected optic nerve determined by ultrasound with brain lesions in acute retrobulbar neuritis in patients with multiple sclerosis. In this ...prospective study 20 patients with multiple sclerosis and acute retrobulbar neuritis were examined. Optic nerve diameter was measured by ultrasound. Brain lesions were detected by magnetic resonance. Correlation between demyelinating lesions of the brain in multiple sclerosis and optic nerve diameter was tested by Kruskal-Wallis test. Significant difference in diameter between healthy and affected optic nerve in acute retrobulbar neuritis was found. Demyelinating brain changes examined by magnetic resonance revealed periventricular lesions, subcortical lesions and lesions in corpus callosum. There is statistically significant correlation between optic nerve diameter and number of brain lesions in multiple sclerosis, p < 0.05. Diameter of optic nerve in retrobulbar neuritis measured by ultrasound correlates with brain lesions detected by magnetic resonance in multiple sclerosis.
Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and ...mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.
The purpose of this study is to present our experience in treating 191 patients with eye and orbit injuries that occurred during the war in Croatia and Bosnia and Herzegovina.
The authors ...retrospectively reviewed the clinical and radiological management of wartime eye and orbit injuries in patients hospitalized at Clinical Hospital Split.
Seventy-nine percent of the war eye and orbit injuries were caused by fragments of explosive devices, 9.9% by high-velocity missiles, and 8.4% by other objects. Most of the patients were admitted to the hospital within 24 hours of injury. The total number of injured globes was 222; 48.2% of globes had intrabulbar (mostly magnetic) foreign bodies, and 13% had extrabulbar intraorbital foreign bodies. Extensive wounds (perforation, double perforation, rupture, and evisceration/ enucleation) were encountered in 74% of patients, and 26% of patients had slight trauma. There was a statistically significant correlation between admission within the first 12 hours and postoperative visual acuity (Chi 2 = 3.93; p = 0.0474).
Along with clinical examination, computed tomography is the most important diagnostic procedure in preoperative evaluation of various forms of globe and orbit injuries. The admission time is the most important factor in determining postoperative visual acuity.
Wartime open globe eye injuries Plestina-Borjan, Ivna; Medvidovic-Grubisic, Maria; Zuljan, Igor ...
Graefe's archive for clinical and experimental ophthalmology,
03/2010, Letnik:
248, Številka:
3
Journal Article
Recenzirano
Background
Open globe injuries are the most serious eye injuries in war as in peace time. The purpose of this study is to analyze wartime open globe eye injuries in 72 patients treated at the ...Department of Ophthalmology, Clinical Hospital of Split from July 1991 to April 1993, during the intensive war in Croatia and Bosnia and Herzegovina, and to evaluate crucial factors responsible for the functional success of the treatment.
Methods
Wartime open globe eye injuries were retrospectively analyzed in 72 patients (80 eyes) hospitalized at Clinical Hospital of Split, Department of Ophthalmology, between July 1991 and April 1993. The causes and ways of wounding, localization of wounds and presence, nature and localization of the foreign body, as well as admission time, microsurgical management and other factors contributing to poor visual outcome were studied. Standard international classification of ocular traumas (the Birmingham Eye Trauma Terminology and the International Ocular Trauma Classification) was used for the classified and graded injuries.
Results
Open globe eye injuries amounted to 52.65% of all war injuries to the eyes. Bilateral injuries were found in eight patients (11.11%). The most frequent cause of the injures were fragments of explosive devices (more than two-thirds). Most of the patients were admitted to the hospital within 24 hours of the injury. Using current microsurgical techniques, the attempt was made to achieve not only anatomical but also functional recovery already in the primary treatment. In 30 eyes (37.50%) final visual acuity amounted to more than 0.1, and in 22 eyes (27.50%) it reached 0.5. There was a statistically significant correlation between admission within the first 12 hours and postoperative improved visual acuity (χ
2
= 4.53;
p
= 0.033). Statistically significantly better visual acuity was found in patients with lesions limited to the anterior segment of the eye. Primary enucleation or evisceration was performed only exceptionally: one enucleation and six eviscerations (8.75%).
Conclusion
The most important factors in the prognosis of postoperational visual acuity for wartime open globe eye injuries were: (1) preoperative condition of the eye, (2) localization and extent of the wound, (3) presence, size and nature of foreign bodies, and (4) adequate surgical treatment in specialized institutions.
In this study, we review the initial clinical and radiological management and early outcomes of 14 patients with orbitocranial war injuries treated at the University Hospital Split between 1991 and ...1995.
This investigation involves 14 patients (13 soldiers and 1 civilian) with orbitocranial war injuries. The mean patient age was 31 years (range, 23-54 years). The penetrating object was a metal shrapnel fragment in 8 patients and a bullet in 6 patients. The results of clinical and radiological management were retrospectively analyzed.
The mean time from the moment of wounding to hospital admission was 6 hours (range, 1-30 hours). The mean Glasgow Coma Scale score was 8 (range, 3-14). Craniotomy was the basic neurosurgical procedure, and three patients were treated with simple scalp wound debridement and closure. Osteoplastic operations of the orbital bones were performed in 13 patients. Enucleation/evisceration was performed in 6 patients (42.8%). At discharge, the mean Glasgow Outcome Scale score was 13, and 1 patient died in the hospital. Blindness (including amaurosis and anophthalmus) was present in nine eyes (8 patients), light-perception positivity and projection positivity were present in four eyes, and visual acuity was at 0.1 in 1 patient.
An early multidisciplinary therapeutic approach and computed tomography as a diagnostic procedure are necessary for a good result in the treatment of orbitocranial war injuries.
Cilj rada bio je ispitati intraoperacijske i poslijeoperacijske značajke kod ugradnje jednodijelne intraokularne leće s filtrom za plavo svjetlo nakon operacije katarakte fakoemulzifikacijom. Ova ...prospektivna studija je uključila 18 bolesnika (18 očiju) podvrgnutih operaciji i ugradnji jednodijelne savitljive akrilatne leće AcrySof SN60AT u razdoblju od prosinca 2005. do veljače 2006. godine. Analizirana je priprema leće za ugradnju, operacijske i poslijeoperacijske komplikacije, ugradnja leće kroz operacijski rez od 3,2 mm, centriranje leće, fleksibilnost haptika, vidna oštrina, zamućenje stražnje kapsule i test na boje. Prilikom pripreme leće za ugradnju nije bilo poteškoća. U tri slučaja vodeći haptik je teže ulazio u operacijski rez, a nakon ugradnje leća se vrlo brzo vraćala u prvobitan oblik. Nije bilo poteškoća s centriranjem unutar kapsularne vreće. Poslijeoperacijska korigirana vidna oštrina je bila 0,85 (Snellenova tablica), što je bilo u skladu s nalazom na fundusu. Bolesnici se nisu žalili na percepciju boje na operiranom oku. Ugradnja jednodijelne intraokularne leće AcrySof s filtrom za plavo svjetlo ne razlikuje se od ugradnje drugih savitljivih leća i ne utječe na percepciju boja i vidnu oštrinu.
Cilj. Istražiti epidemiološke znacajke primarne stecene opstrukcije nazolakrimalnog kanala (PSONK).
Metoda. Ova retrospektivna studija daje pregled hospitaliziranih i ambulantnih bolesnika s PSONK-om ...tijekom razdoblja od 10 godina, tj. od 1994. do 2003. godine u Splitsko-dalmatinskoj županiji, lijecenih na Klinici za ocne bolesti Klinicke bolnice Split. Ukupan broj bolesnika bio je 91.
Rezultat. Godišnja incidencija PSONK-a bila je 1,96 na 100000 stanovnika. Prosjecna dob ± SD bolesnika bila je 64,3 ± 16,0 godina. Bilo je 67 (73,6%) žena i 24 (28,4%) muškaraca. Odnos žena prema
muškarcima bio je 2,8, što je statisticki znacajna razlika (p = 0,000007). Razlike u pojavi bolesti izmedu desne i lijeve strane nisu statisticki znacajne (p = 0,64), a bilateralna pojava je primijecena u 6 (6,6%) slucajeva. Akutni oblik PSONK-a javio se u 50 (54,9%) slucajeva, a kronicni oblik u 41 (45,1%) slucaju.
Iako je prevalencija akutnog oblika PSONK-a nešto veca u toplijim godišnjim dobima (proljece i ljeto), nego u hladnijim (jesen i zima), sezonske varijacije u pojavi PSONK-a nisu statisticki znacajne (p = 0,26).
Zakljucak. Rezultati ove studije su važni jer omogucavaju bolju evaluaciju bolesti i bolje planiranje oftalmološke službe u lijecenju PSONK-a..
The aim of this paper is to compare diameter of healthy and affected optic nerve determined by ultrasound with brain lesions in acute retrobulbar neuritis in patients with multiple sclerosis. In this ...prospective study 20 patients with multiple sclerosis and acute retrobulbar neuritis were examined. Optic nerve diameter was measured by ultrasound. Brain lesions were detected by magnetic resonance. Correlation between demyelinating lesions of the brain in multiple sclerosis and optic nerve diameter was tested by Kruskal-Wallis test. Significant difference in diameter between healthy and affected optic nerve in acute retrobulbar neuritis was found. Demyelinating brain changes examined by magnetic resonance revealed periventricular lesions, subcortical lesions and lesions in corpus callosum. There is statistically significant correlation between optic nerve diameter and number of brain lesions in multiple sclerosis, p<0.05. Diameter of optic nerve in retrobulbar neuritis measured by ultrasound correlates with brain lesions detected by magnetic resonance in multiple sclerosis.
Cilj studije bio je ustanoviti kliničke i patohistološke prognostičke čimbenike preživljenja od melanoma srednje očne ovojnice kod bolesnika s tom bolešću. Provedena je retrospektivna analiza ...kliničkih i patohistoloških podataka 20 bolesnika s histološki dokazanim melanomom srednje očne ovojnice. Bolesnici su operirani u Klinici za očne bolesti KB Split u razdoblju od 1. siječnja 1991. do 31. prosinca 2000. godine. Melanomi su patohistološki verificirani u Zavodu za patologiju, sudsku medicinu i citologiju KB Split. Primijenjeno je standardno HE (hemalaun-eozin) bojenje i imunohistokemijsko bojenje na melanoma antigen i S-100 protein. Uzrok smrti utvrđen je uvidom u mrtvozorničke prijave o uzroku smrti u Zavodu za patologiju, sudsku medicinu i citologiju KB Split i u Matičnom uredu Split, Uredu državne uprave Splitsko-dalmatinske županije. Godišnja incidencija melanoma srednje očne ovojnice u Splitsko-dalmatinskoj županiji bila je 0,44 na 100.000 stanovnika. Od 20 intraokularnih melanoma, 4 (20%) su imala polazište iz zrakastog tijela, 13 (65%) iz žilnice, a 3 (15%) su bila smještena u zrakastom tijelu i žilnici. Nije nađena statistički značajna razlika u preživljenju prema lokalizaciji tumora (χ²=2,747; df=3; p=0,253). Najveći promjer tumora iznosio je 35 mm, najmanji 9 mm (medijan 12 mm). Nije utvrđena statistički značajna korelacija između preživljenja i veličine tumora (Spermanova rang korelacija 0,21). Histološka analiza utvrdila je 1 (5%) melanom vretenastog tipa A, 4 (20%) vretenastog tipa B, 4 (20%) epiteloidnog tipa i 11 (55%) miješanog tipa. Nije dokazana statistički značajna razlika u preživljenju ovisno o patohistološkom tipu tumora (χ²=5,312; df=4; p=0,15). Na temelju dobivenih rezultata može se zaključiti kako niti jedan od ispitivanih parametara (lokalizacija, veličina i patohistološki tip tumora) nije valjan prognostički čimbenik preživljenja kod melanoma srednje očne ovojnice.
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