No abstract

Aim The aim of this study is to quantify visual field defects after temporal lobectomy for mesial temporal sclerosis and to establish eligibility for driving. Methods Automated static perimetry was performed on 14 patients who had undergone anterior temporal lobectomy for mesial temporal sclerosis. Perimetry consisted of monocular Humphrey Field Analyser (HFA) 30-2 test and a binocular Esterman 120 test. Results Of the 14 patients, three had no loss or non-specific loss, eight had partial homonymous quadrantanopia, one had complete homonymous quadrantanopia and two had concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of these, only seven passed the standardised DVLA visual fields. Of the seven who failed DVLA visual field, one had complete quadrantanopia, four had partial quadrantanopia and two had concentric loss (due to vigabatrin). Conclusions Visual field defects contribute a great deal in the reduction of the quality of life in patients who have had surgery for mesial temporal sclerosis. Potential surgically induced visual field defects that could preclude driving need to be discussed with each patient preoperatively. In our study 50% of patients did not meet the required DVLA standards.

No abstract

No abstract

The aim of this study was to assess the eligibility to drive in patients with mesial temporal sclerosis who undergo anterior temporal lobectomy. The two major determinants in a patient's ability to drive after such surgery are visual field defects and their seizure frequency. Thirteen patients were selected. The postoperative seizure frequency was assessed using Engel's criteria. Automated static perimetry was performed which consisted of a Humphrey Field Analyser (HFA) 30-2 Test, one for each eye and a Binocular Esterman 120 Test. Seven out of the 13 (54%) selected patients had no seizures post-operatively (Engel's 1); three (23%) patients had less than two seizures per year (Engel's 2) and three (23%) had more than 90% improvement in the frequency of seizures (Engel's 3). The seven patients with no seizures postoperatively were eligible to apply for a driving licence. Automated static perimetry performed on the same patients revealed three (23%) had normal visual field or non-specific loss, seven (54%) had partial homonymous quadrantanopia, one (8%) had complete homonymous quadrantanopia and two (15%) had bilateral concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of the 13 patients, only seven (54%) passed the standardised DVLA Esterman visual field test. Of the six (46%) who failed DVLA Esterman visual field test, one had complete homonymous quadrantanopia, three had incomplete homonymous quadrantanopia and two had concentric loss (due to vigabatrin). Although seven (54%) patients passed the visual field test and seven (54%) patients were seizure free only five of the seven seizure-free patients (i.e. 38% of the total number of patients) had visual fields that would make them eligible to drive. As driving is now stated by patients' as a major factor that improves their quality of life, it is important to stress the significance of surgically induced or other iatrogenic visual field defects that may prevent them from driving prior to the operation to avoid disappointments afterwards.

Necrotising fasciitis of the periorbital regionNecrotising fasciitis is a life-threatening bacterial infection characterised by necrosis of subcutaneous tissue and underlying fascia, with rapid spread of the infection and inflammation along fascial planes. It rarely involves the face and periorbital region. 1 Early diagnosis and prompt treatment are essential to prevent the high morbidity and mortality associated with this condition.Although Streptococcus pyogenes is the most frequent isolate, a mixture of facultative and anaerobic bacteria can also lead to this condition?,3 We present a case where prompt diagnosis and instigation of appropriate high dose antibiotics limited the need for extensive debridement. Case reportA 37-year-old Caucasian man presented at 4 a.m. to the Eye Casualty. He had allegedly been assaulted and hit with a baseball bat on the right side of his face at 11 a.m. Twenty-four hours later his temperature had lysed and he felt much better but the dark area in the upper lid had worsened and looked necrotic and crusted (Fig. 2).The blood culture and wound swab grew Gram positive Group A streptococci after 3 days. He continued to improve clinically. After 7 days of intravenous antibiotics the woody swelling had subsided but the area of necrosis was larger. He therefore underwent debridement of the upper lid on the eighth day. Three days later he had upper lid reconstruction with axillary skin graft.

No abstract

No abstract