Kaija Tuppurainen

Ocular Side Effects of Amiodarone

Amiodarone is an effective antiarrhythmic agent. During therapy, intracytoplasmic lamellar deposits occur in the cornea, lens, retina, and optic nerve. The most common symptom, reported by 1.4-40.0% of patients, is colored rings around lights. The most common ocular finding is corneal epithelial opacities resembling a cats whiskers in 70-100% of patients; however, lens opacities have been reported in 50-60% of patients. Neither type of deposit impairs visual acuity, and their presence is not contraindicative to continued amiodarone treatment. Retinopathy has, rarely, been reported in association with amiodarone treatment. Optic neuropathy in patients receiving the drug for various lengths of time has been reported as having incidences of 1.3% during the preceding 8 years and 1.76% during the preceding 10 years. Although a causal relationship is not well established, if optic neuropathy is observed, discontinuing or reducing the medication, if not life threatening, should be considered.

Ocular findings in prematurely born children at 5 years of age

Fifty-eight prematurely born children (gestational age ≤ 32 weeks) were studied at the age of 5 years. The ophthalmological examination was part of an extensive neurodevelopmental evaluation. The eye study revealed significant hyperopia (≽ + 2.0) in 22.4%, myopia (≥ − 1.0 D) in 8.6%, astigmatism (≥ 1.0 D) in 12.1 %, and anisometropia (≥ 1.0 D) in 12.1 %. The myopic refractive error was high in all of the cases: from − 6.0 to −14.0 D. Manifest strabismus was found in 24.2% and significant visual impairment or blindness in 6.9%. Optic atrophy and cicatricial retinopathy of prematurity were the main causes for severe visual defects. In the randomly selected full-term children of the same age, significant hyperopia was seen in 14.3%, astigmatism in 5.4% and strabismus in 1.8%. The pattern of the eye findings was different in the preterm children compared with those born at term.

Squamous cell carcinoma of the conjunctiva. Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction.

Abstract. Squamous cell carcinoma of the conjunctiva is a distinct rarity, often arising at the corneoscleral limbus and initially resembling pterygium or chronic keratoconjunctivitis. In this paper we report 4 patients with conjunctival squamous cell carcinomdcarcinoma in situ, which comprise all the cases found in the files of Kuopio University Hospital during 19590–1991. The clinical appearance, diagnosis and treatment of the lesions are described. All biopsies were studied for the presence of Human papillomavirus (HPV) DNA (recently demonstrated in conjunctival squamous cell papillomas, precancer lesions and carcinomas) by using in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). Both techniques failed to demonstrate the DNA of any of the following HPV types: HPV 6, 11, 16 and 18 in any of the lesions. The results are discussed in the light of the recently proposed HPV etiology of these lesions.

The KID‐syndrome in Finland A report of four cases

Abstract. We describe a rare syndrome in a Finnish family, in which the father and his two sons are congenitally deaf and also exhibit corneal vascularization, and hyperkeratosis of the skin of the palms, soles, elbows and knees. In addition, all 3 suffer from fungal infections of the skin and nails. We also describe a fourth, sporadic case of a 9‐year‐old girl with the same disease. The KID (k = keratitis, i = ichthyosis, d = deafness) syndrome is an ectodermal dysplasia that probably arises through mutation, and is transmitted as an autosomal dominant in the family described by us.

Cataract in traffic

Abstract · Background: To obtain a driver’s licence to drive a private passenger car, the binocular visual acuity required is 0.5 or better, and the minimum horizontal width of the visual field is 120°. Persons who fulfill these requirements can obtain a driver’s licence even if they have an eye disease such as cataract. However, contrast sensitivity and visual acuity in glare can be considerably decreased in eyes with cataract, and this may create a risk factor in traffic. · Methods: Examinations of the eyes, visual fields, contrast sensitivity and glare sensitivity (visual acuity in glare and macular photostress test) were performed for 35 cataract patients aged 60 to 87 years (mean 70.1 years±6.1 SD). They had cataract in one or both eyes. In spite of the cataract, the visual acuity was ≥0.5 in 50 of the eyes. Twenty-two control eyes of persons within the same age range were similarly tested. · Results: The results in the contrast sensitivity test were significantly worse in the cataract eyes than in the control eyes. Contrast sensitivity decreased significantly as the visual acuity became worse. In the glare test, none of the control eyes lost any of the lines in the visual acuity chart. In the cataract eyes, the loss of lines with the highest glare varied from 0 to 6 lines (mean 1.4±1.5). The recovery time in the macular photostress test was longer, but not significantly, in cataract eyes than in normal eyes. There was no significant correlation between the loss of visual chart lines and visual acuity or between the recovery time in the macular photostress test and visual acuity. · Conclusion: It would be advisable for traffic safety if simple tests for contrast and glare sensitivity were added to the requirements for a driver’s licence, at least for older drivers. The age and test result limits should be defined.

Color vision defects after central serous chorioretinopathy.

Purpose: To reexamine patients diagnosed with central serous chorioretinopathy (CSC) during the 10‐year period from 1987 to 1996 to identify remaining color vision defects in the eyes with normal visual acuity (VA). Methods: Thirty‐nine patients were found with normal VA of 20/20 (logMAR 0) or better 8 to 166 months (mean ± SD, 58.8 ± 41.2) after active CSC. Color vision was examined with the Standard Pseudoisochromatic Plates part 2, Farnsworth‐Munsell 100 hue test, and Color Vision Meter 712 anomaloscope. Results: Of the CSC eyes, 26 (67%) had a color vision defect, most of them in the blue area. There was no correlation between the time since the active disease and the results on the color vision tests. Of the contralateral eyes, 19 (49%) also had a color vision defect. Conclusion: In many patients some degree of color vision defect remains after CSC even if the VA has recovered to normal. The contralateral eye can also have a color vision defect. This has not been previously reported and might be due to earlier subclinical CSC.

Ocular Münchhausen syndrome induced by incest.

Abstract This report describes a young female patient whose long‐lasting ocular problems were ultimately found to be due to self‐induced damage of the corneas with chemicals, and later, self‐inflicted perforation of the eye with a safety pin. More than one year after these ocular symptoms were presented, it was descovered that the eye diseases were in fact attempts by the patient to escape from the psychic anxieties which were the result of an incestuous relationship between the patient and her father.

Ocular findings among mentally retarded children in Finland.

The distribution of refractive errors, astigmatism, anisometropia, visual acuity and organic ophthalmic diseases were determined among 149 Finnish mentally retarded (IQ < 70) children, aged 9–10 years. The case group was classified in 3 categories according to the degree of mental retardation. The control group (n = 100) was selected by random sampling.

Fabry's disease and cornea verticillata. A report of 3 cases.

Fabrys disease is a rare familial disorder of glycolipid metabolism which is caused by a deficiency of a lysosomal enzyme α‐galactosidase. A Finnish family is described in which cornea verticillata was found in the father and 2 daughters. In all cases, there were symptoms suggesting Fabrys disease: febrile episodes the origin of which was not clear, limb pains and, in the case of the father, 20 years of proteinuria with elevated ESR, and hemiplegia and aphasia following a cerebral thrombosis at the age of 43. The diagnosis was confirmed by demonstration of an α‐galactosidase deficit in the serum and urine of all patients. Deficiency of this enzyme leads to abnormally high urinary tri‐ and dihexosyl ceramide levels, and this was observed in the father and the elder daughter. At the age of 12, the daughter had loss of vision in her right eye as a result of occlusion of the central retinal artery. Electron microscopic (EM) examination of the fathers dermal angioma suggested Fabrys disease. Computerized cranial tomography of the father revealed not only the cerebrovascular condition but also a disease affecting the white matter of the brain.

Usher syndrome type III (USH3): The clinical manifestations in 42 patients

Clinical manifestations of 42 patients with Usher syndrome type III (USH3) were analysed. USH3 differs from the other Usher syndrome types by progression of the hearing loss. Impaired hearing was diagnosed after the child learned to speak at childhood. Hearing deteriorated to severe or profound hearing loss during 5 to 30 years. Out of 42 patients 40 used hearing aids and 2 patients with profound hearing loss did not benefit from them. All but one patient communicated with speech or with a combined speech/signing method. The vestibular function was decreased in 8 out of 17 patients. USH3 appears to form a clinically and genetically distinct entity. However, if the hearing loss starts very early or if its progression is slow, USH3 may be difficult to differentiate from USH1 or USH2.