Alec M. Ansons

Hypotension-induced blindness in haemodialysis patients

Hypotension is a commonly encountered complication in haemodialysis patients and is a significant cause of morbidity and mortality. Bilateral visual loss in dialysis induced hypotension remains poorly recognized as a complication by both renal physicians and ophthalmologists. We report 2 cases of patients on renal dialysis who suffered severe longstanding hypotension with bilateral non-arteritic anterior ischaemic optic neuropathy. Both patients experienced bilateral loss of vision over a short time period. We feel that physicians must be aware of patients complaining of painless visual loss in this high risk group, as control of blood pressure may be the most important factor in prevention of this visually devastating condition.

Midoperative Forced Duction Test as a Guide to Titrate the Surgery for Consecutive Exotropia

This is a retrospective study of the outcome of all consecutive exotropia surgery performed between the years 1999 and 2007. Excluded were cases of slipped muscles, muscle transpositions, and concurrent cyclovertical procedures. A total of 135 patients of mean age 40 years (range 6–72) were operated with a mean preoperative angle of deviation −40Δ (range −12 to −90). Five were treated with fixed sutures and the rest with adjustables. The surgery included preplanned lateral rectus recessions of mean 6 mm (range 2–9) and maximal possible medial rectus advancements with or without resections of mean 5.6 mm (range 2–11), intraoperatively adjusted to give a resistance of +1 to +2 for abduction on forced duction test (FDT). Adjustable suture patients were seen 4 to 6 hours after surgery and underwent further adjustment, if needed, to achieve the target angle. A further review took place at 2 weeks and 2 months. Children remained under follow-up till 8 years of age. Forty percent needed postoperative adjustment. The mean postoperative angle at final measurement was −2Δ (range +25 to −45). Eighty percent achieved an angle within 10Δ of orthotropia. No gross restrictions of ductions were present postoperatively.

Isolated Pupil-Involving Third Nerve Palsy as the First Presentation of Sarcoidosis

Abstract Neurosarcoidosis is seen in 5–15% of patients with systemic sarcoidosis. The most common cranial nerve presentations are optic neuropathy and facial nerve palsy. The authors present a case of sarcoidosis presenting with a pupil-involving third nerve palsy. The patient responded to corticosteroid therapy with resolution of investigations her cranial nerve palsy but progressed to develop cerebellar signs. This is the first documented case of a pupil-involving third nerve palsy occurring as the first presentation of neurosarcoidosis. Although typically a pupil-involving third nerve palsy necessitates urgent neuroimaging to rule out a posterior communicating artery aneurysm, it is important to recognise inflammatory causes in the differential diagnosis.