İnci Güngör

Is Symptomatic Atherosclerotic Cerebrovascular Disease a Risk Factor for Normal-Tension Glaucoma?

Objective: To compare the incidence of glaucomatous optic disk appearance between patients with symptomatic atherosclerotic stroke and healthy individuals with normal intraocular pressures (IOP). Subjects and Methods: 46 patients with ischemic stroke with evident lacunar infarction or large vessel atherosclerosis, and 93 age- and sex-matched healthy individuals, all with normal IOP, were included. Patients and controls were examined for the presence of high cup-to-disk ratios (>0.5). Results: Seven patients (15.22%) in the ischemic cerebrovascular disease (CVD) group and 3 controls (3.23%) had glaucomatous optic disk appearance. All subjects with glaucomatous optic disk appearance in the control group and 3 patients in the study group had visual field defects in concordance with normal-tension glaucoma (NTG). The incidence of glaucomatous optic disk appearance was significantly higher in the group with symptomatic atherosclerotic CVD. Conclusion: Atherosclerotic CVD is a risk factor for having glaucomatous optic disk appearance. Symptomatic atherosclerosis involving the brain vasculature may also affect the eye and lead to NTG. Patients with ischemic strokes due to large artery atherosclerosis or small artery occlusion must be examined and followed for NTG.

Necrotizing scleritis due to varicella zoster infection: a case report.

Purpose: To report a case with necrotizing scleritis due to varicella-zoster infection. Methods: The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region. Results: Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms. Conclusions: Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease.

Conjunctival necrosis due to subconjunctival injection of betamethasone in treatment of graft rejection after penetrating keratoplasty.

A rare side effect of betamethasone applied subconjunctivally is described. A 51-year-old man who had undergone penetrating keratoplasty in his left eye 2 months previously developed graft rejection and was treated by subconjunctival injection of betamethasone. Within 2 weeks, the patient complained of conjunctival hyperemia and irritation. Biomicroscopic examination revealed conjunctival and subconjunctival necrosis with white necrotic tissue at the subconjunctival corticosteroid injection site. Simple debridement and primary wound closure of the involved area resulted in complete healing. Ophthalmologists should be aware that subconjunctival injection of betamethasone may cause conjunctival necrosis.

Lateral canthal dynamics, correlation with periorbital anthropometric measurements, and effect of age and sleep preference side on eyelid metrics and lateral canthal tendon.

Purpose To evaluate dynamic and static properties of lateral canthal tendon and involutional periorbital anthropometric and lateral canthal changes with any possible effect of sleep preference side on these changes. Methods Ninety-two healthy adult subjects with a mean age of 43.5 years were enrolled in the study. Lateral canthal tendon lengths (LCT), canthal movement amplitudes, and other periorbital anthropometric parameters were measured. Any effects of age and sleep preference side on anthropometric and particularly lateral canthal tendon measurements were evaluated. Pearson correlation analysis, one-way analysis of variance, and t-test for paired samples were used for statistical evaluation. Results LCT length was weakly correlated with age, lower lid tractability, horizontal palpebral fissure length, and interpupillary distance and also inversely correlated with margin reflex distance, but not with other measurements. Age was also correlated with lower lid tractability, and with the ratio of LCT to the horizontal palpebral fissure length (LCT/HPFL). No correlation between age and horizontal palpebral fissure length was detected. Age was weakly and inversely correlated with canthal height but not with canthal movement amplitudes. No effect of sleep preference side on LCT length, canthal height, or lower lid tractability was detected. Conclusions Lateral canthus has a dynamic structure that is not correlated with any other periorbital anthropometric measurements. LCT length is correlated with lower lid tractability, and increases with age, unlike horizontal palpebral fissure that stays constant with increasing LCT/HPFL ratio. Sleep preference side has no effect on the eyelid metrics and LCT. (Eur J Ophthalmol 2007; 17: 143–50)

Visual Evoked Potentials in Guillain-Barré Syndrome

Background and Purpose Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. Methods Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. Results The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. Conclusions Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.

Bilateral horizontal Vogt’s striae in keratoconus

Purpose To report a keratoconus case with bilateral horizontal Vogt’s striae. Method The clinical findings of the patient and the development of the direction of striae are discussed. Results Vogt’s striae, defined as vertical stress lines, are rarely horizontal. One patient with unilateral horizontal stress lines on his left eye has been reported in the literature. Our patient has horizontal Vogt’s striae in both eyes. Conclusion Horizontal Vogt’s striae may be seen in keratoconus as a rare slit-lamp biomicroscopic finding.

Methanol-induced toxic optic neuropathy with diffusion weighted MRI findings

Abstract We report a 52-year-old man with methanol intoxication who showed optic nerve damage as assessed by magnetic resonance imaging (MRI). He was admitted to the hospital with blurred vision after the consumption of alcohol (600–700 ml of cologne). He was treated with intravenous ethanol, NaHCO3 and hemodialysis. On admission, a brain and orbital MRI was performed. Bilateral mild contrast enhancement was detected on the contrast-enhanced images in the retrobulbar segment of the optic nerves (RBONs). Also, diffusion-weighted images showed restricted diffusion in the RBONs. Diagnosis was considered as methanol-induced optic neuropathy based on the MRI findings of the optic nerves.

Papillophlebitis: Treatment of Vision Loss Due To Subretinal Fluid with Intravitreal Ranibizumab

Abstract There are no specific treatment protocols for papillophlebitis, which is basically a central retinal vein occlusion (CRVO) occurring in young adults. The present report is that of a 14-year-old girl, who presented with blurred vision in her right eye. Although her visual acuity (VA) was initially 20/20, there were venous engorgements, blurry disc margins, and a substantial collection of subretinal fluid. She was diagnosed with papillophlebitis. When, 2 weeks later, her VA had decreased to 20/200, she was administered intravitreally injected ranibizumab. One week post-injection, her VA had returned to normal (20/20) and the subretinal fluid had diminished markedly. Intravitreal ranibizumab injection appears to be an effective treatment modality for this condition.