Congenital retinal macrovessels are rare and they tend to remain stable. Visual acuity is preserved in most cases. Complications occur only occasionally and have been described in the literature. Differential diagnosis from other arteriovenous malformations affecting multiple organs is necessary.
Purpose To evaluate the 24-h intraocular pressure (IOP) control of brimonidine/timolol fixed combination (BTFC) versus the unfixed combination of its individual components, each dosed twice daily, in patients with primary open-angle glaucoma or ocular hypertension. Methods An observer-masked, randomized, crossover, active-controlled, two-centre comparison. Following a 6-week medicine-free period, patients were randomized to BTFC or to the unfixed combination of brimonidine and timolol for 3 months. Patients then were crossed over to the opposite treatment for another 3 months. At the end of the medicinefree period, and each treatment period, patients underwent 24-h IOP measurements at 0600, 1000, 1400, 1800, 2200, and 0200 hours. Results Twenty-eight patients completed this study. Both BTFC and the unfixed components showed a significant IOP reduction from untreated baseline (Po0.0001), and were statistically equal when compared directly, for each individual time point and for the 24-h IOP curve (P40.05). The mean 24-h IOP was 24.671.9 for baseline, 19.271.9 for BTFC, and 19.271.6 mmHg for the unfixed components (P ¼ 1.0). Four patients were discontinued due to side effects. The most common ocular adverse event was ocular hyperaemia (n ¼ 3 with BTFC and n ¼ 5 with the unfixed components, P ¼ 0.7) and systemic adverse events were rare. Conclusion This study suggests that both BTFC and the unfixed components of brimonidine and timolol provide a significant 24-h IOP reduction from untreated baseline, and statistically equal control when compared directly, at each time point and for the 24-h pressure curve.
Although topical anaesthetic abuse keratitis is rare, it should be considered in the differential diagnosis when we see a patient with a persistent corneal epithelial defect together with a ring infiltration on the corneal stroma. Psychiatric diseases and/or systemic drug abuse are usually associated with this toxic keratopathy. The psychiatric diseases that accompany this toxic keratopathy may also lead to death or to severe handicap as a result of suicide attempts by the patients. Psychiatric consultation and therapy are imperative in the management of such patients.
Severe hypertensive retinopathy with optic neuropathy may be a consequence of malignant hypertension due to a pheochromocytoma. It is reversible after ablation of the tumor. Early diagnosis is of vital importance and relies on hormonal investigation and immunohistochemistry.
Isolated lateral rectus myositis can be a manifestation of idiopathic orbital inflammation. Diagnosis is made by the clinical presentation and imaging with orbital MRI/CT-scans. Other local or systemic inflammatory, endocrine or neoplastic diseases must be ruled out.
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