Breaking News Related to Macular Degeneration, Cataract, Glaucoma, Corneal Disease and Other Eye Conditions » Case Discussions

3 YO Boy With Meningoencephalitis Presenting with Afferent Pupillary Defect (Right Side) and a Sluggish Reacting Pupil on the Left

Doctor Letter to the Editor — Fri, 14 Jan 2011 09:03:30 +0000

What would you suspect in 3 year old boy with three days history of meningoencephalitis presenting with unilateral total afferent pupillary defect (right sided) and a sluggish reacting pupil on the left?

Patient is unconscious and not responding to any stimuli.

Other manoueuvres cannot be elicited.

What Are Treatment Options for a Patient With Bilateral Vision Loss Due to Swelling Affecting Optic Nerve?

Patient Letter to the Editor — Thu, 15 Jul 2010 23:26:28 +0000

I recently had a patient come into my practice (I am a board certified optician in FL) who had inexplicably lost vision bilaterally. It seems that the man’s optic nerve ‘canal’ (his word) had swollen, shutting off blood flow to the eye. This first happened to the right eye, eventually leaving him with virtually no vision (finger count). He then suffered the same issue in the other eye, but has retained 20/60- in that eye. He has been to several “specialists” who have not yet either A) given him a specific root cause (hypertension, diabetes, and a couple other possibilities have been mentioned) and B) he’s been told there really is no help for this, that he could have this happen again, and could lose all vision. So, I came here, as I read this site quite often. Has any one seen this? And/or, the patient and family are talking about ‘stem cells’ and even mentioned the chip technology, but I”m not sure that would have any real efficacy in this case. Any responses would be much appreciated.

Are You Experiencing Difficulties With Retinal Surgery on Patient With Restor Intraocular Lens?

Dr. Randall Wong — Thu, 17 Sep 2009 08:51:42 +0000

I just operated on Friday on a patient with macular pucker. Nothing special pre-operatively. Very easy to see via slit lamp with the aid of a 90D lens. I have been down this path many times. In the OR, I couldn’t focus easily on the ERM. Patient had a Restor® intraocular lens with an open posterior capsule. I don’t know why this was a problem. Was it a problem with me (accomodation?) or a problem with the lens?

I welcome any comments.

Randall V. Wong, M.D.
Retina Specialist
www.RetinaEyeDoctor.com

Can DSEK Help Me Recover My Vision After a Corneal Scar?

Patient Letter to the Editor — Thu, 27 Aug 2009 10:22:07 +0000

Approximately two months ago I had a injury in my left eye. As a result I now have a small scar on my cornea not in the center which restricts my full vision.

I would like to know if this new technique called DSEK (endothelial keratoplasty) would help me recover my full vision or if other treatment could help me.

Diabetic With Hypertension Being Treated for BRVO

Patient Letter to the Editor — Tue, 23 Jun 2009 23:05:21 +0000

I have been treated for BRVO with 2 avastin injections and 2 laser treatments. I am a diabetic and have hypertension.What are the chances that my vision is restored back to the earlier form?

Cataract Surgery for 76 YOM 20/30 Vision Fuchs Dystrophy Guttata 1100 Corneal Thickness 560 MM

Patient Letter to the Editor — Wed, 20 May 2009 14:39:40 +0000

I would appreciate an opinion regarding undergoing cataract surgery with the following criteria:

1. I am 76 years old.
2. Have Fuchs Dystrophy.
3. Corneal thickness of approx 560 Microns in each eye.
4. Guttata count at 1100. No morning edema.
5. 20/30 vision

I have all the symptoms of cataracts.

Question: Treating Macular Edema After Glaucoma and Cataract Surgery?

Dr. Ari Weitzner — Sun, 03 May 2009 04:52:54 +0000

I’ve developed a macular edema after a surgery for glaucoma and cataract. I am treating this with antiinflamatory drop and diamox since 5 weeks but it’s still persisting. Please let me know if you have a better suggestion. Thanks and best regards, Bose

Atypical Case of Corneal Abrasion and Herpes Keratitis

Dr. Ari Weitzner — Mon, 13 Apr 2009 00:58:35 +0000

A 62 year old woman with no significant history told me she struck her right eye with her finger or mascara brush the other day. On exam, there was a large stellate abrasion, but- there was significant folds in the inferior half of the cornea, and a 1+ A.C. reaction. Furthermore, the endothelium had a scalloped appearance. I violated Occam’s razor- the simplest answer/diagnosis (or, in other words, the answer that requires one diagnosis as opposed to two) is the best one and almost always the correct one. I gave her two diagnoses- I figured the scalloped endothelium was posterior polymorphous dystrophy in addition to the abrasion. I gave her Zymar QID. Later that evening, she called me and told me her vision was much worse. I saw her the following day, and her entire cornea was now steamy (though the abrasion was smaller). Now it was clear to me what she had- atypical Herpes. In fact, in hindsight, her relative lack of severe pain on presentation (it was a verly large abrasion) made more of an impression on me and confirmed in my mind that it was Herpes. I started her on Viroptic Q2h, and in 48 hours, the cornea was almost perfectly clear.

So- violate Occam’s Razor at your own peril.

Retina Case Study – 45 YOM with Acute Loss of Vision

Dr. Randall Wong — Thu, 26 Mar 2009 19:13:33 +0000

45 YOM presented this weekend with acute loss of vision in the right eye. Occasional floaters, but no trauma. Successful cataract surgery 2 years ago. Noted progressive, painless, loss of vision over the past 1-2 days. Vision loss started in the periphery and moved centrally. Excellent historian. Past medical history was not contributory, healthy and no history of diabetes. Your differential?

My colleague was on call and went in to examine the patient. Our differential was retinal detachment, vascular occlusion or vitreous hemorrhage. The patient was found to have a dense vitreous hemorrhage. It was now 10:30 PM on Saturday night. B-scan was unremarkable. I asked the patient to follow-up with me this week. Would you have done anything differently at this point?

The patient returned 48 hours later. He reported some slight clearing, but there was still no view of the peripheral retina. B-scan was inconclusive in that there were no gross abnormalities such as retinal detachment. At this point, my differential is retinal tear with vitreous hemorrhage, retinal detachment or the dreaded posterior vitreous detachment (PVD) with no obvious tear. What is my next move, observation, Tissue plasminogen activator (tPA) or vitrectomy?

I have been in practice for 16 years as a retinal physician. I used to think this scenario was routine and easy to manage, but I really feel this is one of the more difficult cases. I highly suspect a tear or even a detachment, but have no concrete evidence that there is a retinal detachment. To restate, I have no clear indication for surgery, i.e. vitrectomy. On the other hand, if you don’t operate, are you willing to take the chance of a retinal detachment developing and possibly involving the macula?

I have become most comfortable operating in this scenario believing it is far more beneficial than observation, although seemingly less conservative. I feel that you have far more to gain by operating. If a retinal tear or detachment is usually the cause, why wait for a retinal detachment to develop?

I operated this morning and found a tear without detachment and a low lying detachment with dialysis.

Looking forward to your comments,

Randall V. Wong, M.D.
Retinal Specialist
www.TotalRetina.com

60 Year Old Man with Submacular Hemorrhage – Intravitreal Injection?

Dr. Randall Wong — Wed, 18 Mar 2009 18:00:50 +0000

A 60 year old male, smoker, presented to my office the other week with complaints of acute vision loss in the left eye. Past medical history was not contributory. There was no history of valsalva. Physical exam included a normal exam of the right eye and a dense submacular hemorrhage of the left eye. Fluorescein angiography did not reveal evidence of choroidal neovascularization. Would you consider intravitreal injections (anti-VEGF of your choice) now or when in the future? If the right eye showed drusen and some pigmentary changes, would this alter your decision of treating?

This is a real patient of mine. I have elected to follow him, have no evidence of CNV, but suspect he may require an injection (I prefer Avastin) in the near future. I see him weekly.

How about you?

Randall V. Wong, M.D.
www.TotalRetina.com