M. Serrador-García

Clinical relevance of foveal location on retinal nerve fiber layer thickness using the new FoDi software in spectralis optical coherence tomography.

PURPOSE To evaluate the effect of improper foveal location on retinal nerve fiber layer (RNFL) thickness measurements by using the new FoDi software in spectral-domain optical coherence tomography (Spectralis SDOCT). METHODS Cross-sectional study with 126 subjects: 66 healthy, 30 early, and 30 moderate glaucomatous eyes. Fast RNFL scans were performed by using the new FoDi technology. The position of the fovea was manually displaced inferiorly after acquisition (producing clockwise torsion of scan circle) and then superiorly (counterclockwise) to generate study sets of images. Differences in RNFL thickness between foveal-guided and alternative scans were analyzed and color changes in sector charts were evaluated. RESULTS In healthy eyes, placing the fovea inferiorly led to significant RNFL thickness changes in all sectors. Locating the fovea superiorly seemed to have less impact. Early glaucomatous eyes were more susceptible to quantitative changes, but moderate glaucomatous eyes were more susceptible to qualitative changes. CONCLUSIONS Improper fovea disc alignment when using the FoDi software in Spectralis OCT significantly affected sectoral RNFL thickness measurements and color chart representation. As final report of FoDi analysis does not show the foveal position used, careful acquisition is encouraged, so that results are reliable. Otherwise, this technique can easily be misinterpreted and patients could be misdiagnosed.

Charles Bonnet plus syndrome: apropos of a case.

Purpose Charles Bonnet syndrome plus is an exceedingly rare variant of this disorder. The variant has been described in patients with sight impairment and severe hypoacusis, and is usually characterized by complex visual and auditory—musical—hallucinations that the patients recognize as unreal. Methods Case report. Results A 75-year-old woman diagnosed with Usher syndrome presented with visual acuity of light perception in both eyes, which did not improve with the use of a pinhole occluder. She also had coptosis in right ear and severe hypoacusis in left ear, confirmed through audiometry. Audiometric tests were normal once the implant and the hearing aid were connected. The patient was referred to the Neuro-Ophthalmology Unit after recounting experiencing complex visual hallucinations, as well as auditory (musical) ones at night after disconnecting the hearing aid. She described the latter as a nightly occurrence of hearing “cabaret music.” Nevertheless, she was aware of reality and of her sensory impairments. The patient was diagnosed at the interdisciplinary Neuro-Ophthalmology Unit, and began pharmacologic treatment with clear improvement. Conclusions Knowledge of Charles Bonnet syndrome and in particular of Charles Bonnet syndrome plus—due to its infrequency—on the part of ophthalmologists is fundamental to adequately diagnose and treat this rare disorder.

Simultaneous optic and vestibulocochlear syphilitic neuropathy in a patient with HIV infection

BackgroundThe purpose of this report is to present a case of optic and vestibulocochlear neuropathy as a manifestation of concurrent HIV and syphilis coinfection. This is an interventional case report of a 37-year-old man who complained of blurry central vision in his left eye and hearing loss in his left ear over the past 2 weeks.FindingsVisual acuity was 20/20 in both eyes, and the anterior segment was normal in both eyes without relative afferent pupillary defect. Fundoscopy revealed swelling of the left optic disc. Optic coherence tomography and the Heidelberg retina tomograph confirmed and quantified the oedema of the left optic disc. An audiometry showed a left sensorineural deafness. Serological examinations disclosed confirmed HIV and syphilis infection. Magnetic resonance imaging of the brain showed no abnormalities. Properly treated with intravenous penicillin, the lesions resolved.ConclusionsSimultaneous optic and auditive involvement can be the first manifestation of syphilitic and HIV coinfection. To our knowledge, this report is the first to describe the rare occurrence of syphilitic optic neuritis and ipsilateral affectation of the vestibulocochlear nerve.