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

The review deals with therapeutic aspects of optic nerve diseases. Attention is given to the lack of established guidelines for treatment of different optic neuropathies. In fact, there are no sure protocols in the literature for infective, inflammatory and vascular disorders. The authors present some new drugs and discuss the efficacy of related therapy, in particular for vascular disorders. The differentiated therapy for arteritic and non-arteritic AION is discussed. Treatment of vascular occlusion in the acute phase, in the post-occlusive state and prophylaxis is reported. The usefulness of anticoagulants is examined. In the conclusion, the authors stress the necessity to carry out properly controlled multicenter trials to obtain valid knowledge that allows rational and effective therapy protocols.

Cigarette smoke contains detectable amounts of cyanide, regardless of the type of cigarette. The very high levels of this compound in plasma of amblyopic smokers suggests that cyanide causes optic neuropathy. The detoxification of cyanide in man occurs through various metabolic pathway; the most important are those that use sulfur to transform cyanide into thiocyanate. One of the richest sources of reduced sulfhydryl groups is reduced glutathione (GSH). For this reason we investigated red cell GSH levels in non-smokers, in healthy smokers and in smokers affected by optic neuropathy to ascertain whether this compound is a marker of the disease. Red cell GSH levels in the non-smokers group were similar to those of affected smokers. On the contrary, GSH levels in healthy smokers were significantly more elevated. During therapy with vitamin E we noted that the concentration of GSH decreased with the progression of the disease and increased with recovery. Moreover, there was a good correlation between GSH levels and clinical findings. Our findings demonstrate that GSH plays a key role in the detoxification of cyanide and so it could be a marker of tobacco smoke-induced optic neuropathy.

A three-month old, premature female infant is presented with severe bilateral occult ocular damage comprised of cataracts, lenses dislocation, retinal hemorrhages and total funnel-shaped retinal detachment without external signs such as bruises. This severe eye trauma is the result of child abuse. We would like to alert pediatricians as well as ophthalmologists that any ocular injury should raise the possible diagnosis of battered child syndrome even in the absence of other supportive evidence of external trauma.

The histopathological features made on 18 autopsies have proved that the optic nerve head drusen are calcified formations situated within the margins of the optic nerve head. It has been supposed that not only an aberrant axoplasmic transport, but also the presence of local factors, partly depending on the Bruch's membrane, can play a determining role in the pathogenesis of the optic disc drusen. A spongiotic edema gives us the histopathological equivalent of the clinical aspect of the optic disc with indistinct margins and lack of the central cup and furthermore gives us an explanation about the perimetric alterations pathogenesis. Clinical observations confirm that the optic nerve head drusen are prevalently asymptomatic and that visual acuity remains unchanged. The threshold tests are able to quantify exactly the entity and the depth of the visual field defects and its possible changing within a certain period of time. As regards the diagnosis, the retinal fluoroangiography is of great importance allowing to distinguish clearly a pseudo-papillary edema from a papillary edema.

The contribution given by manual perimetry to differential diagnosis of optic neuropathies is described. The advantages and the disadvantages of automated perimetry in respect to manual perimetry are examined. The programs to use for a more precise diagnosis and according to different pathology are also examined. The problems connected to perimetric interpretation are discussed. The value of global indices in evaluating the visual field as well as the importance of statistical program in comparing more than one test performed are reported. The review stresses the usefulness of automated perimetry in early diagnosis and in the follow up of optic nerve diseases.

Overdosage of radiation in the treatment of retinoblastoma is agreed upon as the main cause of chorioretinopathic complications and is due to following the conventional empirical dosages blindly. A clinical assessment is substituted and a lower dose proved effective and prevention or at least minimizing the degree of complications is achieved.

In normal individuals fluorescein angiography of the optic nerve head has some peculiar signs. Three early phases can be distinguished, they include: 1) retrolaminar and laminar filling, 2) prelaminar filling, 3) superficial capillary filling. A late staining is also part of the fluorescein angiography of a normal disc. Many optic nerve disturbances show changes of the above mentioned angiographic signs. The Authors discuss the fluorescein angiographic pattern of 1) anterior ischemic optic neuropathy, 2) central retinal vein occlusion, 3) papilledema and 4) drusen.

Controlling the natural tendency to rebleed in this condition is important because the serious vision threatening complications usually follow rebleeds. In evaluating treatments, it has been difficult to determine the natural rebleed rate. Recent reports on traumatic hyphema suggest that the natural rebleed rate in this condition may be higher in blacks and young children than in Caucasians and older children and adults. The records of 38 patients who were admitted to a children's hospital and who were the untreated control group in a previous study on systemic steroid treatment for traumatic hyphema, were reviewed to determine their ethnic background and age. The data was examined to see if these characteristics were related to the rebleed rate. The overall rebleed rate in this untreated group was 32% (12 out of 38). For specific ethnic groups, the rebleed rate was: Caucasians, including presumed Hispanics--32% (10 out of 31); Caucasians, not including presumed Hispanics--33% (8 out of 24); presumed Hispanics--29% (2 out of 7). There was no statistically significant (P greater than .95) difference in rebleed rates. With regard to age, the rebleeding rate was 54% (6 out of 11) for children under six years of age, and 22% (6 out of 27) for those over six years of age. This was a statistically significant difference (P less than .05). Ethnicity, therefore, in this group of untreated patients did not affect the natural rebleed rate. Younger age, under six years, is associated with a higher natural rebleed rate in traumatic hyphema, and these children should be most carefully treated.