We used a digital image processor to make multiple measurements from the fluorescein angiograms of 53 cases of central serous chorioretinopathy (CSC) associated with single leaks. We determined the area of the base of each serous detachment, the location of its geometric center (CM), the area of the RPE leak, the distance from the fovea to the leak, and the distance from the leak to the CM. The distribution of leaks across the base of the detachments was nonrandom (P less than 0.005) with leaks clustering near the centers of the detachments. When the leak was found within 1 disc diameter from the fovea, the center of the detachment was located virtually at the foveola, suggesting that the central macula is predisposed to the development of CSC. Detachments associated with "smokestack" leaks were significantly larger than those associated with round pinpoint leaks (P less than 0.02).
One hundred eyes of 100 patients in whom Tenon's cysts (TCs) developed in the early postoperative period following trabeculectomy with mitomycin C were retrospectively studied to determine their incidence, possible risk factors associated with their development, and the clinical course of the patients in whom they occurred. The incidence of TC formation was 29/100 (29%). Significantly more cysts developed in the men than in the women. There were no significant differences between those patients in whom TCs developed and those in whom they did not in terms of age, race, type of preoperative medications, mean preoperative intraocular pressure (IOP), prior argon laser trabeculoplasty, prior trabeculectomy, prior Tenon's cyst formation, or prior cataract surgery. The 29 patients in whom a Tenon's cyst developed had a mean follow up of 22.0 ± 12.9 weeks, with a mean IOP at the last examination of 14.2 ± 6.3 mm Hg (as compared with 20.7 ± 8.3 mm Hg at the time of diagnosis). One patient required a repeat trabeculectomy with mitomycin C. Two patients required bleb needling, subsequent TC excision, and eventual seton placement. Of the remaining 26, 14 (54%) required no glaucoma medication for IOP control, 11 (42%) required one, and 1 (4%) required two.
To determine if pilocarpine 4% produces miosis when delivered via a spray, eleven eyes of ten patients undergoing a laser peripheral iridotomy for occludable angles were pretreated with one application of pilocarpine spray to closed eyelids. Standardized pupil photographs for pupil diameter measurements were taken before and thirty minutes after the spray. Contralateral eyes served as controls (9 eyes) All treated eyes achieved miosis. The mean pupil diameter in the treated group was 4.1+/-0.9 mm before the spray and 1.5+/-0.3 mm after the spray (p < 0.0001). The average change in pupil diameter in the treated group was 2.6+/-0.9 mm compared to 0.0+/-0.2 mm in the control eyes (p < 0.0001). Pilocarpine spray is an effective delivery modality for intraocular miosis.
CaseOur patient, MD, is an 18-month-old female who originally presented with intermittent left lower leg pain. She would grab her left lower leg and cry out for approximately 60 seconds, from 2 to 4 times per day. No fevers were noted and review of systems was otherwise negative. She had no limp when walking or running. After the 60 seconds, she would return to normal. There was no history of trauma per parents. Physical exam was normal with full range of motion of all joints without tenderness elicited or swelling. A complete blood count (CBC) was drawn at that time and was normal.MD returned for follow-up 8 days later. She was now refusing to walk after episodes of pain. Physical exam remained unchanged with no bruising noted. Bilateral lower extremity radiographs were obtained and were normal. Orthopedics examined child and found no evidence of musculoskeletal abnormalities.At this time, the patient began to have episodes of emesis when drinking large quantities of milk (>8 oz). Mother originally cut back the quantity, but MD continued to have emesis even with smaller quantities. Mother tried soy/lactose free diet, but emesis continued and increased in frequency. She was still able to take clear liquids without emesis. The child seemed hungry, would eat and then vomit the food within 5 to 45 minutes after feeds. Supine abdominal radiograph was normal.The emesis began to increase in frequency and was now occurring with any oral intake. She had decreased urine output. Review of systems revealed that the child was constipated with no stools in the past 5 days. Physical exam was again normal with no focal neurological deficits. Several labs were sent, including urinalysis, CBC, erythrocyte sedimentation rate, hepatic function panel, and lipase were normal. Basic chemistry was significant for hyponatremia of 129 mmol/L, hypochloremia of 96 mmol/L, and bicarbonate of 19.Enemas were given with large amount of hard stool released. Patient was able to tolerate liquids in the emergency room without emesis after enemas.She was brought back to the emergency department 2 days later with recurring emesis with oral intake. Physical exam again was unremarkable. A noncontrast head computed tomography (CT) was done and was read as normal with no evidence of hydrocephalus. The child was admitted to pediatric ward for intravenous fluids and further workup. An upper gastrointestinal series and abdominal ultrasound were done, which were read as normal. IgA, TTG, ammonia, lactate, and prolactin were normal.During this time parents noted that MD seemed to be having headaches when she awoke from sleep and magnetic resonance imaging (MRI) of the head was performed. MRI revealed multiple, extra-axial and intra-axial, nonenhancing lesions with low to intermediate T1, and intermediate to high T2 and fluid-attenuated inversion recovery (FLAIR) signal intensities (Figures 1 and 2). These lesions demonstrated mild diffusion restriction and there was extensive extramedullary, intradural spread throughout the spinal canal. A cervical tap was d...
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