Pierre-François Kaeser

Visual Loss After Orthopedic Procedures

Perioperative visual loss (PVL) is a very rare and unpredictable complication of surgery performed at distance from the visual pathways, mostly after spine or cardiac procedures. We report 6 consecutive patients with PVL after routine orthopedic procedures (osteosynthesis for complex fracture of the femur [2], total hip arthroplasty [2], hip prosthesis arthroplasty [1], bilateral simultaneous total knee arthroplasty [1]) and reviewed the literature on the subject. An ischemic optic neuropathy was diagnosed in all cases, and visual loss was bilateral in 5 of 6 patients. Partial visual improvement occurred in only 3 of 11 eyes. No specific therapy is available for PVL. Postoperative visual disturbances should prompt without delay an ophthalmic evaluation because emergent correction of anemia, systemic hypotension, or hypovolemia might improve visual prognosis of PVL.

Absence of the fourth cranial nerve in congenital Brown syndrome

Purpose:  To elucidate the aetiology of congenital Brown syndrome.

Peripapillary neovascular membrane: a rare cause of acute vision loss in pediatric idiopathic intracranial hypertension.

We report a 14-year-old boy who presented with vision loss secondary to peripapillary neovascular membrane (PPNVM) as the initial and only symptom of papilledema secondary to idiopathic intracranial hypertension. After one lumbar puncture, visual acuity progressively recovered during the course of 1 week and further improved with the administration of oral acetazolamide. One year after the onset of vision loss, the patients visual acuity had recovered to baseline measurements. The previously active PPNVM had involuted into a residual peripapillary fibrotic scar. To our knowledge, this is the first report of PPNVM complicating idiopathic intracranial hypertension in a child.

Acute reversible Charles Bonnet syndrome precipitated by sudden severe anemia

Purpose To report the sudden onset of reversible Charles Bonnet syndrome precipitated by acute severe anemia. Methods The charts of three patients (Usher syndrome, bilateral macular degeneration, and bilateral retinal vein occlusion) with acute Charles Bonnet syndrome in the setting of severe anemia were reviewed. Results Anemia resulted from bladder surgery, recto-colitis, and severe urinary tract infection. Hemoglobin ranged from 78 to 86 g/L. Decreased visual acuity and formed visual hallucinations (giants, flowers, animals) were present in all three patients. Rapid reversal of Charles Bonnet syndrome and visual acuity improvement followed blood transfusion. Conclusions Acute severe anemia can precipitate Charles Bonnet syndrome, which may be reversible by blood transfusion.

Altered vision during motion: an unusual symptom of cerebellar dysfunction, quantifiable by a simple clinical test

Acta Ophthalmol. 2010: 88: 791–796

Results of Anterior Tucking of the Superior Oblique Muscle Tendon in Bilateral Fourth Nerve Palsy

BACKGROUND Bilateral fourth nerve palsy is characterised by excyclotorsion, which can be corrected by reinforcement of the anterior tendon fibres of the superior oblique muscle. PATIENTS AND METHODS A retrospective study of 40 consecutive patients with bilateral acquired fourth nerve palsy operated by a selective tuck of the anterior portion of the superior oblique tendon between 1994 and 2012 was undertaken. Horizontal, vertical and torsional deviations were measured in 9 diagnostic positions of gaze and the field of binocular single vision was evaluated with the Harms tangent screen. Postoperative follow-ups took place at 1 week, 6 months, and ≥3 years. RESULTS Preoperative mean excyclotorsion was 9° in the primary position and 15° in downgaze. These values decreased to 2° and 5° 6 months after surgery, and 2.5° and 6° at ≥3 years. Immediate post-operative incyclotorsion in upgaze (28 patients) and Brown syndrome (15 patients) regressed spontaneously. The median score of field of binocular single vision improved from 4% preoperatively to 76% postoperatively. CONCLUSIONS The selective tuck of the anterior tendon fibers of the superior oblique tendon enables an efficient and long-lasting correction of the ocular torsion induced by bilateral trochlear palsy.