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

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.

Eye examination was performed in a series of 53 patients whose mean age was 19.5 years (range from 11 to 25 years), affected from Cooley's disease, in treatment with transfusions and desferrioxamine in subcutaneous infusion. The most frequent ocular change was fundus mottling appearance like "leopard skin" (15%). We found also lens opacity (11%), drusen (7%), retinal venous tortuosity (5%), without impairment of visual acuity. The pathogenic factors of the ocular change are related to abnormality of iron metabolism. These results suggest that the involvement of desferrioxamine to remove iron from the eyeball is relatively small.

Findings are reported for a 70-year-old man with a progeria-like syndrome consisting of premature aging (per history), diffuse wasting, skin atrophy, disseminated skeletal osteoporosis (documented for at least 25 years), especially in the vertebral column and metacarpal joints with short stature, beaked nose and high-pitched voice, The ocular findings include: spontaneous bilateral dislocation of spherophakic mature cataracts into the vitreous together with bilateral retinal vasculitis, characterized by venous congestion, tortuosity and occlusion, To the best of our knowledge, there is no case report with all the above features in one person, Hence, the differential diagnosis will also be discussed.

Reduced visual acuity apparently due to the effects of drusen on the optic nerve is rare. We describe two young patients with central vision impairment from optic disk drusen: a man with a reduction of visual acuity to light perception, a women with a very fast evolution of the drusen, that, not visible at the clinical onset, could be documented in autofluorescence one month later. The appearance of drusen in disks initially diagnosed as pseudopapilledema is supposed to be related to axonal degeneration from abnormal axoplasmic flow.

The authors outline the historical development of anatomical and physiological acquisitions on the optic nerve. From the first descriptions of Alcmaeone of Crotone (6th century B.C.) through the Aristotelean school, we arrive at the systemization of Claudius Galen. After the medioeval parenthesis, it fell to Vesalius to give a new impulse to anatomical research. Varolio and Eustachi describe the exact point of origin of the optic nerves. Later observations involve both anatomists and physiologists. The question of the transmission of sensory messages is described (Willis, von Haller), as is the microscopic structure of the optic nerve (Zinn, von Leeuwenhoek). After the description of the decussation of the fibers of the optic nerve in the optic chiasma, research into this cranial nerve has an increasingly neurophysiological and neurochemical orientation, continuing until the recent discovery of axoplasmic flow.

Different neurotransmitter systems in the retina and optic nerve can be modified during aging. An increase in GABA and dopamine receptor density in the retina of senescent rats has been demonstrated. Lack of data exists on the aging-related changes in optic nerve neurotransmitters. However, it is possible that neurotransmitter changes in the optic nerve at the lateral geniculate nucleus are similar to those in other areas of central nervous system.

The pathology of the optic nerve in the advanced elderly has been investigated at autopsy in a sample of 50 subjects (43 males, 7 females), aged 95-103 years. Septal fibrous thickness and slendering of nerve fibers were the most frequently encountered lesions as well as degenerative processes involving the cribriform lamina. Other significant features included gliosis, demyelination, and corpora amylacea. Complete arteriosclerotic disease was rarely observed. The results of the present study suggest that optic nerve pathology in aged people is almost the consequence of an inadequate blood supply; nevertheless, the degree of these lesions does not seem to parallel that usually observed in other sites particularly injured by ischemic disease.

We investigated the various segments of optic nerve microangioarchitecture in the aging eye. Some clinical results were obtained.

Perimetry analyzes the efficiency of the entire visual system, but reveals the deterioration of even one of its components. Optic nerve changes, especially those of ischemic nature, which most frequently involve the middle and advanced age, cause typical perimetric findings. Manual kinetic perimetry is particularly indicated for the detection and definition of sectorial and global contractions. Manual static perimetry provides precise information on defect depth. Automated static perimetry quantifies the defect density in a large number of positions and also provides data on the significance of changes recorded during the follow-up. In normal subjects every type of perimetry shows a physiological decay of light sensitivity as a consequence of the aging of the visual system (about 2 dB per decade) and the reduced efficiency of the optic nerve is undoubtedly one of the components of this functional deterioration.