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Purpose: To study the subfoveal choroidal thickness (SFCT), macular ganglion cell layer (GCL-IPL) and central macular thickness (CMT) in Caucasian children, and to analyze these optical coherence tomography (OCT) parameters depending on the spherical equivalent (SE). Methods: Cross-sectional study of SFCT, GCL-IPL, and CMT in Caucasian children, analyzed with spectral-domain OCT Cirrus 5000 and Enhanced-depth imaging technique. Correlation between these three OCT parameters, age, sex, and spherical equivalent was analyzed. The eyes were classified into three groups: group 1 included eyes with SE < 0, group 2 included eyes with SE between 0 and +2.00, and group 3 eyes with SE > +2.00. Results: Hundred ninety-eight eyes of 121 subjects were studied. The mean age was 9.22 years (range 3–16); 61.1% were female. The mean SFCT was 351.04 ± 84.08 µm, being 310.04 ± 82.84µm in group 1 (n = 62), 373.14 ± 83.16 µm in group 2 (n = 71) and 365.18 ± 73.16 µm in group 3 ( n = 65); statistically significant differences were found between groups 2 and 3, compared with group 1. GCL-IPL thickness was significantly thinner ( p Conclusions: SFCT and GCL-IPL thickness were significantly thinner ( p

Purpose: To evaluate the efficacy of Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) in differentiating between optic nerve head drusen (ONHD) and optic disc oedema (ODE). Methods: This was a cross-sectional study of 140 patients: 83 patients with ONHD (49 hidden and 34 visible), 20 patients with pseudopapilloedema (without drusen), and 37 patients with ODE. EDI-OCT of the optic nerve was performed, selecting one high-resolution line from the HD 5-line raster protocol. Two observers blindly evaluated the presence of a hyporeflective core surrounded by a hyperreflective margin or border. The sensitivity, specificity, predictive values and posttest probability were evaluated as well as the inter-observer agreement (k). Results: EDI-OCT demonstrated a sensitivity of 92% (95% CI: 83%–96%), a specificity of 96% (95% CI: 87%–99%), with a positive predictive value of 97% and a negative predictive value of 89%. The inter-observer agreement was as remarkable as k = 0.8985 (95% CI 0.8252–0.9718). A positive EDI OCT increases the posttest probability to 97% (95% CI: 91%–99%); when negative, the posttest probability is reduced to 12% (95% CI: 6%–21%). Conclusion: EDI-OCT allowed for differentiation between ONHD and ODE with high sensitivity and specificity.

Purpose: To evaluate if fundus photography is useful to study the size of the optic disc in patients with optic nerve head drusen (ONHD). Methods: Cross-sectional study. Fifty-five patients with ONHD confirmed by B-scan echography and 52 patients’ normal controls were studied. Fundus photography was done in all the cases with a telecentric optical system FF450 IR plus from Zeiss with 20° magnification and Visupac measuring system. We measured total optic disc area, vertical and horizontal diameter. Results: Patients with ONHD had smaller optic disc area 2.6 ± 0.55 mm2 (mean ± SD), horizontal diameter (1.68 ± 0.18 mm) and vertical diameter (1.94 ± 0.28 mm) than normal controls (2.93 ± 0.43 mm2, 1.86 ± 0.14 mm and 1.98 ± 0.17 mm, respectively). Significant differences were found in area (p = 0.002) and horizontal diameter (p

Objective The aim of this study was to describe clinical features unique to supratrochlear neuralgia. Background The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. Methods From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. Results Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. Conclusions Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade.

Objective To compare the incidence of diplopia after topical or regional injection anesthesia in cataract surgery. Study design Retrospective, noncomparative interventional case series. Participants and methods Three thousand five hundred forty-two consecutive cataract surgeries, performed from March 1998 to December 2001, were studied. Main outcome measures Incidence and mechanisms of diplopia. Results Two thousand one hundred twenty-two patients were operated under regional and 1420 under topical anesthesia. Twenty-four cases of diplopia were observed, 21 (87.5%) in the regional group and 3 (12.5%) after topical anesthesia ( P = 0.005). Eleven cases (45.8%) were secondary to motility problems, all in the regional anesthesia group ( P = 0.006). Eight cases (33.3%) were secondary to refractive errors or intraocular lens luxation, 5 after regional and 3 after topical anesthesia ( P = 0.88). Five cases (20.8%) were secondary to fusion loss, all in the regional anesthesia group ( P = 0.06). Conclusions In our study, topical anesthesia was associated with a lower incidence of diplopia relative to regional injection anesthesia. No cases of diplopia secondary to fusion loss or muscle damage were found after topical anesthesia surgery.

Background We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. Methods This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. Results During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. Conclusions Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.

Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital neuralgia, external compression headache, nasociliary neuralgia, occipital neuralgias, and auriculotemporal neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 ± 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.

Idiopathic trochleitis is a cause of superimposed ocular pain in patients with migraine. Trochleitis usually presents as an orbital pain without obvious ocular signs. Like greater occipital neuralgia, trochleitis may sustain or trigger the pain of chronic migraine. Diagnosis is confirmed by peritrochlear steroid injection, which produces a quick relief of periocular symptoms and may improve headache control.

The purpose of this observational-retrospective study was to assess which type of conjunctival injection and related phenomena are present during SUNCT attacks. We studied the videorecords of 23 SUNCT attacks in three patients. Conjunctival injection was found to mostly involve vessels of the palpebral territory stemming from both superior and inferior palpebral vessels that supply the tarsal conjunctiva and most of the ocular (bulbar) conjunctiva. Episcleral injection was also observed. During attacks, the appearance of the conjunctiva suggested conjunctival edema or chemosis. Furthermore, the presence of edema below the capsule of Tenon was strongly suspected. During SUNCT attacks, there was a dramatic conjunctival congestion of the eye on the symptomatic side that tended to extend to the rest of the external tunica of the eye.

To assess the efficacy of using autofluorescence to identify optic nerve head drusen (ONHD) in children.We conducted a cross-sectional, descriptive study of subjects18 years of age with possible pseudopapilledema due to ONHD. B-scan ultrasonography was considered the gold standard diagnostic technique. All participants underwent an extensive ophthalmic examination that included fundus color photography, autofluorescence analysis, and B-scan echography. ONHD were classified as visible or hidden. Autofluorescence images were analyzed by three observers who were masked to the results of B-scan ultrasonography.A total of 24 children with pseudopapilledema were included. B-scan ultrasonography confirmed ONHD in 32 eyes of 18 patients (9 boys). Mean patient age was 12 years (range, 7-17 years). ONHD was bilateral in 14 patients; unilateral in 4. The majority of the drusen were hidden (26 of 32 eyes). Analysis of autofluorescence patterns identified the drusen in 94% of cases (30 of 32 eyes): visible, 100%; hidden, 92%. Interobserver agreement was high (κ = 0.91, κ = 0.96, κ = 0.89).In this study cohort, autofluorescence proved a safe, fast, and reliable technique for identifying ONHD in children.

PURPOSE. To report a case of symptomatic myopic retinoschisis with foveolar detachment and lamellar macular hole, treated with expansible gas. METHODS. Interventional case report. A myopic patient presented with a history of decreased vision and metamorphopsia in his right eye. Optical coherence tomography (OCT) revealed an increased macular thickness, thinning and separation of the inner and external retina (retinoschisis or foveoschisis), foveolar detachment, lamellar hole, and foveolar vitreous traction. We treated the patient with a single dose of 0.2 mL of perfluoroethane (C(2)F(6)), performed under retrobulbar anesthesia, followed by prone posturing for 15 days. RESULTS. OCT showed reattachment of the foveolar retina, disappearance of the retinoschisis, and visual acuity improvement. CONCLUSIONS. Intraocular expansible gas and prone posturing, without vitrectomy, could be an alternative treatment in selected cases of symptomatic macular foveoschisis with foveolar detachment, in the absence of dense epiretinal membranes. (Eur J Ophthalmol 2010; 20: 473-5) 0.980 JCR (2010) Q3, 39/56 Ophthalmology

Changes in intraocular pressure (IOP) elicited by a Valsalva manoeuvre were studied in 11 male patients (mean age 39.8 years) suffering from episodic cluster headache (CH), and 12 healthy male controls (mean age 39.9 years). The tests were performed at rest and while exhaling hard through a mouthpiece connected to a mercury manometer. In the CH group, during symptomatic periods, between attacks, Valsalva manoeuvre elicited an asymmetric increase in IOP with significantly higher values on the symptomatic side ( P = 0011), whereas no asymmetric increments in IOP were found during asymptomatic periods. Outside the cluster period the IOP values both baseline and with Valsalva manoeuvre did not differ from controls. The increment in IOP took place within a few seconds, as in spontaneous CH attacks, thus pointing to a rapid increase in intraocular blood volume or vasodilatation. These findings may reflect a latent increased vascular reactivity of the symptomatic orbit during CH period.

To compare the incidence of diplopia after topical or regional injection anesthesia in cataract surgery.Retrospective, noncomparative interventional case series.Three thousand five hundred forty-two consecutive cataract surgeries, performed from March 1998 to December 2001, were studied.Incidence and mechanisms of diplopia.Two thousand one hundred twenty-two patients were operated under regional and 1420 under topical anesthesia. Twenty-four cases of diplopia were observed, 21 (87.5%) in the regional group and 3 (12.5%) after topical anesthesia (P = 0.005). Eleven cases (45.8%) were secondary to motility problems, all in the regional anesthesia group (P = 0.006). Eight cases (33.3%) were secondary to refractive errors or intraocular lens luxation, 5 after regional and 3 after topical anesthesia (P = 0.88). Five cases (20.8%) were secondary to fusion loss, all in the regional anesthesia group (P = 0.06).In our study, topical anesthesia was associated with a lower incidence of diplopia relative to regional injection anesthesia. No cases of diplopia secondary to fusion loss or muscle damage were found after topical anesthesia surgery.

In cluster headache (CH), autonomic signs are usually reported as ipsilateral to the painful side. However, quantitative studies1 have proven bilateral increase of both lacrimation and nasal secretion during attacks, predominantly on the symptomatic side. Although conjunctival injection also seems bilateral but predominant on the side of the pain,2 no objective estimation of ictal conjunctival injection has been performed. Therefore, we sought to witness CH attacks and study the pattern of ictal conjunctival injection in both eyes. Over 1 year we studied all consecutive patients who met IHS diagnostic criteria for CH3 and agreed to participate and sign informed consent. All patients had normal neurologic and ophthalmologic examinations. Routine blood and urine analysis and brain MRI examinations were also normal. Patients were asked not to take any medication before the study was performed. Interictally and during attacks, high quality pictures centered in both eyes were taken under the same conditions of light, magnification, and exposure …

A study was made of the incidence of colonorectal tumors in the Autonomous Community of La Rioja (Spain) over 10-year period between 1978 and 1987, inclusive. An increased incidence of these tumors is confirmed, with no decline in the age of presentation or in the frequency of detection of early tumors, which suggests that this disease is on the rise. In view of these results, measures leading to the early diagnosis of colonic tumors are needed, such as screening of the general population, particularly groups at risk.

The pseudotumor cerebri is characterized by increased intracranial pressure in the absence of a space occupying lesions or obstruction to the circulation of cerebrospinal fluid (CSF). Increased pressure but normal composition of the CSF is the diagnostic criterion. Ear infections and other infections such as sinusitis have been cited as possible, but rare, causes.A 12 year old girl presented with diplopia 10 days after starting treatment for sinusitis. On examination there was paresia of the VI cranial nerve to the left eye and marked bilateral papilledema. She had normal visual acuity with visual field measurements showing increased blind spot field in both eyes. Resonance studies only showed maxillary sinusitis. CSF pressure was 35 cm H2O, with 40 lymphomonocytes and normal biochemical findings. After 15 cm of CSF had been removed treatment was started with acetazolamide, dexamethasone and cefotaxime. A week later the diplopia had disappeared and the CSF pressure was 25, with no cells present. Two months later the visual fields and fundus oculi were normal. After follow-up for one year there was no recurrence.We describe a case of pseudotumor cerebri associated with maxillary sinusitis. We do not know whether this is a chance association or whether there was a pathophysiological basis. The possibility should be considered so as to treat the cause or predisposing factor. The initial CSF pleocytosis would support the possibility of a relationship of the pseudotumor with an infectious condition (meningeal irritation or para-infectious pleocytosis meningeal irritation or para-infections pleocytosis in the context of an ENT infection), which might have precipitated the problem by interfering with the reabsorption of CSF.