Oedipism: bilateral self-enucleation.
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Adult↗
Biomedical subjects
Robert Casson
Publications and source records attributed to Robert Casson.
Ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position.
OBJECTIVES: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. DESIGN: Interventional case report. METHODS: An 80-year-old man underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia. MAIN OUTCOME MEASURES: Clinical course, imaging findings, management, and final outcome. RESULTS: Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements. CONCLUSION: It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.
Acetazolamide↗
Multifocal objective perimetry compared with Humphrey full-threshold perimetry in patients with optic neuritis.
BACKGROUND: The aim of the study is to compare multifocal visual evoked potential (mfVEP) objective perimetry with Humphrey full-threshold visual field (HVF) perimetry, in the assessment of patients with optic neuritis (ON). METHODS: We assessed 16 patients with clinically diagnosed ON. A comparison was made between the HVF and mfVEP, based on the global severity indices of both tests and number and topography of significant abnormalities detected. The latency data and inter-eye asymmetry findings on the mfVEP were also evaluated. RESULTS: From a total of 128 quadrants analysed in the 16 patients (100 affected, 28 unaffected eyes), HVF perimetry identified a scotoma in 39/128 (30.5%) quadrants, all of which were in affected eyes; the mfVEP detected a scotoma in 68/128 (53.1%) quadrants using amplitude and/or asymmetry data (XV2=7.2485, P=0.0071). Latency plots on the mfVEP identified a significant latency deviation cluster in 20/25 (80%) affected eyes. Abnormalities were also detected in 4/7 (57%) unaffected eyes. The global severity indices in the affected eyes showed a high correlation between the two tests (r=0.73). CONCLUSIONS: The mfVEP detected more abnormalities in patients with ON than HVF perimetry. The use of latency recordings as well as combined amplitude and asymmetry plots is advantageous and has the potential to detect abnormalities not otherwise detected on HVF perimetry.
Adolescent↗
Mitomycin: clinical applications in ophthalmic practice.
Mitomycin (mitomycin C; MMC) is an antibiotic isolated from Streptomyces caespitosus. The drug is a bioreductive alkylating agent that undergoes metabolic reductive activation, and has various oxygen tension-dependent cytotoxic effects on cells, including the cross-linking of DNA. It is widely used systemically for the treatment of malignancies, and has gained popularity as topical adjunctive therapy in ocular and adnexal surgery over the past 2 decades. In ophthalmic medicine, it is principally used to inhibit the wound healing response and reduce scarring of surgically fashioned ostia. Hence, it has been used as adjunctive therapy in various ocular surgeries, such as glaucoma filtering surgeries, dacryocystorhinostomy, corneal refractive surgery and surgeries for ocular cicatrisation. In addition, it has been used as an adjunct in the surgical management of pterygia, ocular surface squamous neoplasia, primary acquired melanosis with atypia and conjunctival melanoma. In many of these surgeries and ophthalmic pathologies, MMC showed a significant beneficial effect.
Antibiotics, Antineoplastic↗
Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery.
PURPOSE: The aim of this study was to present a series of patients with acute orbital inflammatory symptoms secondary to peribulbar hyaluronidase allergy and to discuss the diagnostic and management modalities. METHODS: Review of clinical records of all patients with acute orbital inflammatory symptoms after uneventful cataract surgery, seen at two ophthalmology departments. The main outcome measures included clinical signs and symptoms, imaging findings, post-operative course, skin allergy testing, and final outcome. RESULTS: There were five patients (four women, one man) with a mean age of 78+/-7.0 years. Signs and symptoms appeared 12-72 h after cataract surgery and included axial proptosis, periorbital erythema with swelling, and extraocular muscle (EOM) function restriction (5/5), periorbital pain or itchiness (3/5), and conjunctival chemosis (4/5). Computerized tomography showed increased orbital fat haziness and enlargement of EOM. Treatment with a combination of oral antibiotics and steroids or antihistamines resulted in resolution of signs and symptoms after 3-5 days. Intradermal and/or skin prick allergy tests were positive for hyaluronidase and negative for all other perioperative medications used. CONCLUSION: Although uncommon, allergy to peribulbar hyaluronidase injected during cataract surgery should be considered in the differential diagnosis of patients who present with acute post-operative orbital signs and symptoms.
Aged↗
Measurement of retinal injury in the rat after optic nerve transection: an RT-PCR study.
PURPOSE: In the current study, a non-histological approach, namely semi-quantitative RT-PCR, was used to provide information on retinal ganglion cell (RGC) injury and survival after optic nerve transection (ONT). The levels of mRNAs synthesized by RGCs and glial components were initially measured at defined time points after ONT. Subsequently, a comparison was made between the levels of these mRNAs in the ONT retinas of rats treated with the neuroprotectant BDNF and in rats which received vehicle. METHODS: Wistar rats received an ONT in one eye, while the fellow eye served as a control. ONT was performed 1-2 mm from the optic disc without damaging the retinal blood supply. In the first experiment, rats were killed at 1, 3, 5, 7, and 21 days after ONT. In the second experiment, brain derived neurotrophic factor (BDNF; 5 microg) or vehicle was injected intravitreally at the same time as the ONT and animals were killed after 7 days. RESULTS: After ONT, mRNA levels of RGC markers (NF-L and Thy-1) decreased substantially, while levels of GFAP and certain trophic factors mRNAs increased significantly. Administration of BDNF resulted in a substantial, but not complete, preservation of the levels of the RGC specific mRNAs, while ONT induced increases in GFAP and trophic factor mRNAs were not reduced to any great extent by BDNF. CONCLUSIONS: The present studies show that measurement of NF-L and Thy-1 mRNAs provides a sensitive and reliable index of RGC injury after ONT, while measurement of GFAP and trophic factors mRNAs provides more general information on the effect of the injury on the retina.
Animals↗
Autoimmune bullous diseases: ocular manifestations and management.
The ocular manifestations of autoimmune bullous diseases are common and potentially sight-threatening. Major ophthalmic involvement is most commonly seen in mucous membrane pemphigoid (cicatricial pemphigoid), epidermolysis bullosa acquisita, linear IgA bullous disease, pemphigus vulgaris and paraneoplastic pemphigus. The main pathological process is related to autoimmune-induced conjunctival inflammation with consequent lid and corneal pathology, which may eventually result in permanent visual loss. Ocular involvement can be asymptomatic. Early detection is aided by careful attention to symptoms and signs of early ophthalmic disease. Ocular disease can be difficult to treat and management usually involves systemic therapy with immunomodulators to control inflammation and prevent progression to irreversible blindness, as well as surgical intervention in advanced disease. Recent advances in treatment, including methotrexate, mycophenolate mofetil, monoclonal antibodies and topical tacrolimus therapies, have led to promising results.
Administration, Topical↗
Prevalence of trachoma and diabetes-related eye disease among a cohort of adult Aboriginal patients screened over the period 1999-2004 in remote South Australia.
BACKGROUND: To determine the prevalence of trachoma and diabetes-related eye disease within the adult Aboriginal population screened by the South Australian Eye Health Program between 1999 and 2004 inclusive. METHODS: The South Australian Eye Health Program visited 22 Aboriginal communities in remote South Australia. Visiting ophthalmologists and optometrists systematically collected data on the cohort of adult patients seen over the period 1999-2004. Prevalence and grade of trachoma according to World Health Organization classification and the prevalence and degree of diabetic retinopathy according to the Early Treatment Diabetic Retinopathy Study and National Health and Medical Research Council guidelines were recorded. RESULTS: A population of 1651 Aboriginal patients was examined. Sixty-two per cent were female and 38% were male. Twenty patients (1.2%) had evidence of active trachoma with 260 (15.7%) patients having either lid scarring, trichiasis or corneal opacity. There was no significant association between gender and the prevalence of trachoma (P = 0.48). Seven hundred and seventy-one patients within the examined population had diabetes mellitus (46.70%). Significantly more women than men were affected and prevalence increased with age (P < 0.0001). One hundred and sixty-nine patients (22%) with diabetes mellitus had features of diabetic retinopathy, and of these patients 77 had background diabetic retinopathy (46%) and 92 (54%) had either proliferative diabetic retinopathy or maculopathy. Prevalence of clinically significant macula oedema among those with maculopathy (14 of 50 patients) was 28%. CONCLUSIONS: The data suggest that although trachoma is still endemic in this South Australian Aboriginal population the prevalence and severity are less than previously reported. Diabetes mellitus has a high prevalence within this population and great potential for detrimental visual sequelae.
Adolescent↗
Aboriginal versus non-Aboriginal ophthalmic disease: admission characteristics at the Royal Adelaide Hospital.
BACKGROUND: The purpose of the study is to compare characteristics of Aboriginal patient hospital admissions with non-Aboriginal admissions to the Ophthalmology Unit of the Royal Adelaide Hospital. METHODS: A retrospective review of separation data was undertaken of hospital inpatient and day surgery admissions to the Royal Adelaide Hospital Ophthalmology Unit for the period July 1997 to January 2005. RESULTS: There were 11 944 admissions to the Ophthalmology Unit (including inpatients and day surgery cases), of which 273 (2.29%) were Aboriginal patients. Of the total, 2779 (23.3%) patients were admitted for at least 24 h (inpatients), and 9165 (76.7%) stayed less than 24 h (mostly day surgery cases). Aboriginal patients comprised 6.8% of inpatient admissions, and 0.9% of admissions less than 24 h. The average age of Aboriginal patients (52.9 years) was significantly less than non-Aboriginal patients (62.6 years; P < 0.0001). The median length of stay for Aboriginal patients was 5 days compared with 3 days in non-Aboriginal patients. Aboriginal patients were more likely to be from interstate (RR 10.3 P < 0.0001), more likely to have diabetes mellitus (RR 2.7 P < 0.0001), and more likely to be admitted for cataract surgery (RR 4.18 P < 0.0001) and lid disorders (RR 6.04 P < 0.0001) than non-Aboriginal patients. CONCLUSION: Aboriginal patients admitted to the Ophthalmology Unit were younger in age, more frequently from interstate, and had longer admissions than non-Aboriginal patients. These results have important implications for ophthalmic health-care planning.
Eye Diseases↗