Metabolic, pediatric, and systemic ophthalmology (New York, N.Y. : 1985)最新文献

The authors report the clinical history of a patient with bilateral oedema of the optic nerve head, visual field implication, fluorescein-angiographic and electrofunctional result disturbances, but with maintenance of a normal visual acuity. The etiopathogenetic hypothesis are prospected.

While large excavation, elevation and drusen of the optic disc are best detected with contact B-scan examination, standardized A-scan echography is needed to investigate properly and to differentiate optic nerve disease. Increased subarachnoidal fluid within the retrobulbar optic nerve, optic nerve atrophy and optic nerve tumors (glioma and meningioma) can be evidenced with standardized echography. Techniques and examples of ultrasound diagnosis of optic nerve disease are presented and discussed.

A case is reported of an asymptomatic unilateral jet-black mass lesion of the optic nervehead with contiguous iuxtapapillary choroidal pigmentation; unilateral ocular hypertension was present in the affected eye. Diagnosis of melanocytoma with contiguous choroidal nevus was made and an 18 month follow-up was performed. The diagnostic work-up and the importance of follow-up of melanocytoma-affected patients are stressed.

The authors report bilateral papilledema in a 14 year old boy with brucellosis. Papilledema disappeared completely about one month after the clinical recovery of brucellosis, treated with rifampicin and minocicline, without associated steroids or non steroidal anti-inflammatory drugs.

Firstly, the more distinctive features of the morphology and semeiology of the normal optic disk and peripapillary region are discussed. The authors then outline the principal morphological and functional characteristics of glaucomatous optic neuropathies. An appropriate description of the optic disorders which may resemble glaucoma follows. This section reviews separately the vascular disorders considered the most significant from the point of view of frequency and clinical scope, and non-vascular disorders of a heterogeneous nature (toxic, inflammatory, degenerative, malformative and compressive). Finally, the dangers of diagnostic confusion in such cases are mentioned and the most pertinent clinical characteristics for the differentiation between glaucomatous and glaucomatous-like forms are discussed.

Many optic neuropathies and subtle maculopathies may have similar clinical presentations. This represents a challenge to the ophthalmologist to distinguish between the two on clinical grounds. These patients may not have obvious signs and their symptoms may be ambiguous. For example, a young man presenting with optic neuritis may have similar complaints to one suffering from central serous retinopathy. Several general principles can be used to distinguish between optic neuropathies and maculopathies. Additionally, specific psychophysical tests can be of help. The most important aspect of the history is in establishing the tempo of onset, duration and resolution of the symptoms. Optic nerve lesions often produce symptoms described as dimness or grayness, whereas macular lesions usually reduce visual acuity and produce metamorphopsia. The clinical examination requires comparing optic nerve function studies (afferent pupillary defects, color vision and brightness sense) to visual acuity. Additionally, assessing the central visual field especially through Amsler grid testing or threshold Amsler grid testing is very useful. Certain psychophysical tests can be performed in the office. Threshold amsler grid testing, photostress testing, contrast sensitivity, and the Pulfrich phenomena can all be put to advantage in distinguishing between optic neuropathies and maculopathies.

The authors present the A and B scan echographic images of a patient affected with Terson's syndrome. The images show the possible continuity between the vitreous hemorrhage and the hemorrhage in the optic nerve sheaths.

Magnetic resonance imaging (MRI) delineates the orbital soft tissue excellently and is a valuable diagnostic tool in optic nerve pathology. By using different imaging parameters some examples are shown of demarcation of optic nerve tumors, optic nerve inflammations and orbital diseases surrounding the optic nerve. Whereas CT appears to be superior to MRI only in the detection of calcified perioptic meningiomas, MRI provides unique visualization of optic canal and even subarachnoidal space of retrobulbar optic nerve in peculiar cases.

The introduction of automated recording and processing systems, the development of electro-optical technologies, and the numerous findings deriving from experimental electrophysiology have intensified the interest in electrofunctional non-invasive tests for optic pathways studies. Pattern ERG was demonstrated as the most efficacious stimulus to investigate the ganglion cell activity. The contrast sensitivity measurement by means of electrofunctional methods, contribute to obtain more information about the retinal and optic pathways functionality. The utility of electrofunctional and psychophysic methods in some pathologies of optic pathways (diabetes opticopathy, endocular hypertension, retrobulbar neuritis) is discussed.

The optic disc may be variously involved in cases of retinoblastoma at the first discovery or during the follow up after treatment. The differentiation between the various modes of involvement is essential as some of them may be confused with recurrence and the clinician might resort to unnecessary drastic measures like enucleation. Examples of the various pictures are mentioned.