Thomas L. Slamovits

Optic Nerves Sheath Meningiomas: Clinical Manifestations

A retrospective clinical study of optic nerve sheath meningiomas based on 22 patients showed that symptoms most commonly develop in women between the ages of 35 and 60 years. The most common presenting symptoms were decreased vision and transient visual obscurations. In the earliest stages, many patients presented with normal to mildly impaired acuity (despite subjectively decreased vision), optic disc edema and enlargement of the blind spot. Optic disc edema was frequently associated with refractile bodies indicative of chronic swelling. Optic disc edema preceded the development of optic atrophy. Another group of patients presented with a history of longstanding vision loss, visual acuity of 20/200 or worse and optic atrophy. Optociliary shunt vessels were late findings only seen in five patients. The most consistent visual field abnormality was peripheral constriction. Cecocentral scotomas were uncommon. Intracranial involvement was present in five patients. There were two patients with bilateral optic nerve sheath meningiomas without CT evidence of intracranial involvement. Computerized tomography was found to be indispensable in the diagnosis of optic nerve sheath meningiomas and the detection of intracranial involvement.

Acute and Subacute Orbital Myositis

Of 12 consecutive patients (nine women and three men ranging in age from 18 to 70 years) with orbital myositis, four had histories of ocular or systemic autoimmune disease. Five patients treated within two weeks of developing acute orbital pain and extraocular muscle dysfunction were classified as having acute myositis. They responded to corticosteroids within 72 hours although three had single recurrences during six- to 16-month follow-up periods. No patients were heterotropic or proptotic at the final examination. Seven patients with less severe or atypical symptoms who had delays of two or more months between onset and treatment were classified as having subacute myositis. All had recurrences with five having two or more. Three required supplemental radiation therapy during seven- to 20-month follow-up periods. At the final examinations, six patients had motility defects and one had proptosis, indicating that delays in treatment may lead to recurrences, extraocular muscle dysfunction, and proptosis.

Fascicular Arrangement in Partial Oculomotor Paresis

We treated two patients with partial oculomotor paresis who had pupillary mydriasis, marked inferior rectus muscle weakness, and medial rectus muscle paresis, which were attributed to an ipsilateral fascicular lesion, demonstrated on neuroimaging studies. These cases support the fascicular proximity of inferior rectus muscle and pupillary fibers and suggest that fascicular medial rectus and inferior rectus muscle fibers are adjacent to each other.

Orbital Fine-Needle Aspiration Biopsy

Fine-needle aspiration was used as a primary orbital diagnostic technique in 156 patients. A 20-mm syringe, a 22-gauge, 3.75-cm needle, and a plastic pistol grip were used. Local anesthetic was not necessary. When the needle is in the lesion, small to-and-fro movements with a minimum of angulation are helpful. The aspirate is spread on slides fixed with alcohol. Positive cytologic identification was made in 125 of 156 cases. Commonly identified lesions included metastatic carcinoma, inflammatory lesions, and lymphoid lesions. Small posterior apical lesions are difficult to aspirate, but are often the most rewarding diagnostically. Fine-needle aspiration was not successful in tumors of fibrous consistency, in those located in the orbital apex, or in lymphocytic lesions with specimens inadequate for diagnosis.

Visual Recovery in Two Patients after Intravenous Methylprednisolone Treatment of Central Retinal Artery Occlusion Secondary to Giant-cell Arteries

Two patients with central retinal artery occlusions secondary to biopsy-proven giant-cell arteritis lost visual acuity to no light perception but recovered to baseline acuity after treatment with intravenous methylprednisolone at a dose of 15 to 30 mg/kg/day. The potential advantages and theoretical basis of early and aggressive treatment with large-dose intravenous corticosteroids in arteritic central retinal artery occlusion are discussed.

Simultaneous intraocular and orbital non-Hodgkin lymphoma in the acquired immune deficiency syndrome

BACKGROUND Non-Hodgkin lymphoma is more common in patients with the acquired immune deficiency syndrome (AIDS), and the incidence of non-Hodgkin lymphoma in the AIDS population has been increasing as the life expectancy of these patients has increased. Nevertheless, intraocular lymphoma, as part of primary central nervous system lymphoma and orbital non-Hodgkin lymphoma, has rarely been reported in patients with AIDS. Co-existent intraocular and orbital lymphoma is exceptionally unusual. The clinical and histopathologic findings are reported in a patient with AIDS who had simultaneous intraocular and orbital non-Hodgkin lymphoma. The clinical funduscopic findings initially were attributed to a viral retinitis. METHODS A left orbital biopsy followed by enucleation of the left eye was performed and studied by light microscopy. Immunophenotyping of the orbital biopsy also was performed. FINDINGS Simultaneous intraocular and orbital large cell malignant lymphoma was present with neoplastic spread directly along the scleral canal of the ciliary nerve. Massive necrosis involving the retina, retinal pigment epithelium, choroid, and optic nerve, as well as several solid retinal pigment epithelial detachments, were observed. Immunophenotyping of the orbital tumor disclosed positive staining for Leu 4 (T cells, 30%) and Leu 14 (B cells, 60%). Immunostaining for light and heavy chains was precluded by tumor necrosis. CONCLUSION Non-Hodgkin lymphoma should be included in the differential diagnosis of acute retinitis, and proptosis in patients with AIDS.

Spasmus nutans associated with optic gliomas in infants

Monocular and binocular visual evoked responses were obtained with a strobe flash, stimulating at 1.08 Hz. The flash was positioned 100 cm from the patients nasion; 128 responses were averaged, with the amplifier pass band set at 0.3 to 300 Hz. The VERs were abnormal bilaterally, with significant delay when stimulating one or both eyes and with no. significant difference between the left and right eyes. An early positive peak between 60 and 76 msec occurred after stimulation of either eye, followed by a negative peak at 120 msec and the main positive peak at about 240 msec. Lateneies to single-eye stimulation were 80, 130, and 280 msec, respectively. ACT examination revealed a moderately large mass in the region of the optic chiasm, with uniform enhancement after intravenous injection of contrast material. Cortisol and growth hormone assays yielded normal results. A ehiasma[ astrocytoma was subtota[ly resected with the Cavitron Ultrasonic Surgical

Thyroid carcinoma metastatic to the globe.

We report a case of thyroid carcinoma metastatic to the globe. In our survey we found thyroid carcinomas to metastasise to the eye rarely. In addition, we found metastases from the thyroid to be more common to the orbit than to the globe--a reverse of the pattern noted with tumours in general.

Visual Recovery in Patients With Optic Neuritis and Visual Loss to No Light Perception

We reviewed the records of 151 patients with optic neuritis examined over an eight-year period. Of these patients, 12 developed visual acuity of no light perception during the first episode of optic neuritis in the affected eye. Eight of the 12 patients recovered visual acuity of 20/40 or better. Of these, five patients had visual acuity of 20/20 or better, one had visual acuity of 20/25, one had visual acuity of 20/30, and one had visual acuity of 20/40. Four of the 12 patients recovered peripheral visual fields but had dense central scotomas and visual acuity of less than 20/400. Dyschromatopsia persisted after visual recovery in 11 of 12 patients.

Fine Needle Aspiration Cytology of Orbital Masses

OBJECTIVE To review our experience with fine needle aspiration of orbital lesions. STUDY DESIGN Over an eight-year period, 24 orbital fine needle aspiration (FNA) samples were recorded, 22 of them adequate for interpretation. RESULTS There were two benign tumors. There were 14 malignant tumors, 5 primary, 8 metastatic and 1 malignant and originating in the nasal cavity, invading the orbit. In two cases the original tissue diagnosis was incorrect and was revised by the fine needle aspirate. There were six nonneoplastic cases. In one case an infectious agent was identified, and another showed atypical lymphoid cells. Of the two nondiagnostic cases, one was compatible clinically with an orbital pseudotumor, and the other had no available follow-up. A specific diagnosis was achieved in 18 of 24 instances, or 75% of the cases. CONCLUSION FNA is useful in the workup of an orbital lesion, leading to prompt diagnosis and treatment.