Ahmad M. Mansour

Congenital Dacryocele: A Collaborative Review

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21% of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage.

Optic Disk Size in Ischemic Optic Neuropathy

We measured the horizontal diameter, vertical diameter, and area of the optic disk in fellow eyes of patients with unilateral nonarteritic ischemic optic neuropathy and in control eyes without ocular disease. The fellow eyes of patients with anterior ischemic optic neuropathy had a smaller horizontal than vertical disk diameter (P less than .05), a difference not present in controls. Both the horizontal disk diameter and the disk area were significantly smaller in fellow eyes of patients with anterior ischemic optic neuropathy than in controls (P less than .05). There was no statistical difference in the vertical disk diameters between the two groups. Our findings suggest that a small disk area along with a horizontal shortening of the scleral canal can lead to crowding of optic nerve fibers, predisposing to a circulatory compromise of the optic nerve head in non-arteritic anterior ischemic optic neuropathy.

RACIAL VARIATION OF OPTIC DISC SIZE

The optic disc size was measured in 125 volunteers without ocular disease. The horizontal disc diameter and the disc area were significantly smaller in whites and Hispanics than in non-American Indians, Orientals and blacks, and smaller in females than in males. There was no correlation between disc size and age. Future studies analyzing optic disc morphometry need to account for the influence of sex and race.

Ocular Findings in the Velo-cardio-facial Syndrome

Velo-cardio-facial syndrome is a common genetic syndrome of cleft palate, learning disability, heart disease, and abnormal facial appearance. Ocular findings include retinal vascular tortuosity, posterior embryotoxon, narrow palpebral fissures, suborbital discoloration, small optic nerves, iris nodules, and cataracts. Retinal vascular tortuosity was found to be associated intrinsically with the syndrome and not secondary to the heart disease. The ocular and systemic findings suggest a primary developmental anomaly of neural crest derivatives in the pathogenesis of the syndrome.

Retinal Hemorrhage in an Infant After Cardiopulmonary Resuscitation

Unexplained retinal hemorrhages in infants are usually indicative of child abuse. We present the case of an infant with retinal hemorrhages following cardiopulmonary resuscitation, who had not been abused. Cardiopulmonary resuscitation should be added to the list of causes of retinal hemorrhages in infants and children.

Evolution of angioid streaks

Angioid streaks of the fundus are not apparent at birth. In order to study their evolution, we examined in a retrospective manner the fundus pictures of 111 subjects with angioid streaks. The earliest form of angioid streaks became apparent at age 8 with findings of narrow short radial discontinuous hypopigmented streaks. Thereafter angioid streaks enlarged in length and width. The end-stage was disciform macular degeneration, helicoid peripapillary atrophy, or diffuse choroidal sclerosis with obscuration of the angioid streaks. We conclude that angioid streaks represent a dynamic manifestation of an underlying retinochoroidal degenerative process.

Macular Degeneration in Angioid Streaks

This study examines different clinical parameters and the occurrence of macular degeneration in a series of 110 patients with angioid streaks of the fundus. Among the parameters considered were: age of the patient at the time of ocular diagnosis, associated systemic disease, optic nerve drusen, peau dorange appearance in the fundus, number of radiating angioid streaks as well as their length, width, and distance from the fovea. Statistically significant correlations were found between the occurrence of macular degeneration (of the exudative hemorrhagic type) and the following: angioid streak length, distance from the fovea, and the diffuse type or cracked egg-shell fundus appearance.

Choroidal tuberculomas without evidence of extraocular tuberculosis.

A 32-year-old man developed unilateral visual loss. Disseminated large choroidal nodules and granulomatous optic neuropathy were observed in one eye and responded to antituberculous therapy with return of vision. There was no clinical evidence of extraocular tuberculosis. Disseminated choroiditis can be the presenting sign in tuberculosis and the single accessible yet noninvasive evidence for spread of the mycobacteria.

Half-Life of Cotton-Wool Spots in the Acquired Immunodeficiency Syndrome

Cotton-wool spots are a hallmark of human immunodeficiency virus (HIV) retinopathy in the acquired immunodeficiency syndrome (AIDS). We analysed the half-life of cotton-wool spots in AIDS in a prospective study, and found the average time to disappearance to be 6.9 weeks. HIV retinopathy differs from diabetic retinopathy in having a smaller size cotton-wool spot and a much shorter half-life, suggesting a patchy involvement of the retinal capillaries in AIDS and a widespread capillary disease in preproliferative and proliferative diabetic retinopathy.

Long-Term Follow-Up of Dominant Macular Dystrophy with Flecks (Stargardt)

We present a family with dominant macular dystrophy and flecks (Stargardt) which was followed for 20 years. Twenty-three subjects out of 48 members in 4 generations underwent fundoscopic examination. Nine asymptomatic patients had a few scattered, small, whitish, drusen-like changes in the posterior pole, and an additional patient had several clumps of increased pigmentation at the level of the retinal pigment epithelium in the macular region. Five patients had macular degeneration, with the onset of visual loss at between 24 and 30 years of age. The maculopathy started as fine, punctate, pigmentary changes, with transmission retinal pigment epithelial defects (as seen angiographically), or as flecks. The maculopathy progressed into a garland of perifoveal, subretinal flecks with small, central, areolar, chorioretinal atrophy. At the end-stage, there was a larger, central area of choroidal atrophy and a wider wreath of subretinal flecks. Visual acuity stabilized at the 20/200 level. Visual loss preceded clinically visible choroidal atrophy and was coincident with the accumulation of flecks in the foveal region.