Biomedical subjects
Publications and source records attributed to S Dotan.
Pituitary abscesses are rare. Occasionally they will arise in pre-existing pituitary pathology. We report such an occurrence within a Rathke's cleft cyst. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology.
PURPOSE: To describe a 59-year-old patient who had seven recurrent, self-limited episodes of isolated ipsilateral abducens nerve palsy in the previous 4 years. Each episode lasted between 2 and 5 weeks. METHODS: Systemic examination and neuroimaging studies were performed. RESULT: Repeated comprehensive examination failed to demonstrate any ocular or systemic condition apart from a lateral protrusion by dolichoectasia of the posterior portion of the cavernous left internal carotid artery, compressing the posterior left cavernous sinus. CONCLUSION: Numerous self-limited episodes of sixth nerve palsy may be associated with structural abnormalities of the intracranial carotid vasculature.
Five patients with mild to moderate retinopathy to both eyes underwent complication-free cataract surgery in one eye. Within three months of surgery deterioration of the retinopathy was observed in the operated eye only. In four patients there was an increase of intraretinal haemorrhages and hard exudates, accompanied by clinically significant macular oedema manifested as retinal thickening and extensive fluorescein leakage from both the macular and the peripapillary capillary networks. Of these four patients one also developed retinal ischaemia, evident ophthalmoscopically by flame-shaped haemorrhages and cotton-wool spots and angiographically by areas of capillary non-perfusion. The fifth patient showed proliferation of new blood vessels and vitreous haemorrhage. Diabetic patients scheduled for cataract surgery should undergo a thorough preoperative evaluation of any existing retinopathy. Postoperatively they should be followed up at close intervals so that any progression of retinopathy can be promptly detected and considered for laser treatment.
The course of diabetic retinopathy following cataract extraction was studied retrospectively in 89 patients (89 eyes). Cataract extraction was extracapsular in 12 eyes (13.5%), extracapsular with intraocular lens implantation in 37 (41.6%), and intracapsular in 40 (45%). In 55 eyes (61.8%) there was no change in the retinal status after surgery, and in 34 (38.2%) there was progression of diabetic retinopathy. In the eyes showing progression there was appearance or aggravation of non-proliferative changes in 85.3% and development of proliferative diabetic retinopathy in 14.7%. Most of these eyes (91%) deteriorated within six months of surgery. Risk factors for the progression of diabetic retinopathy were the preoperative existence of diabetic retinopathy (p less than 0.005) and the need for antidiabetic agents in addition to dietary control in the management of diabetes (p less than 0.025).
There was a high incidence of ocular trauma (6.8% of all casualties) in the Lebanon War, 1982, which is similar to the rates in previous Arab-Israeli wars. Combat in the Lebanon War consisted of both armored warfare and infantry operations, with much of the fighting taking place in built-up areas. Consequently, there were two main types of ocular injuries: perforating eye injuries caused by the small high-velocity missiles that characterize armored combat, and a wide range of injuries to the eye caused by ricochets during combat in built-up areas. The latter injuries varied in severity from complete destruction of the eye to minor corneal erosions. Not a single eye was injured in soldiers who had ballistic protective goggles properly placed over the eyes at the time of injury. Most of the ocular trauma could have been prevented had the goggles been in universal use. A considerable degree of eye protection is also afforded by ordinary ophthalmic eyeglasses.
Three patients (a 51-year-old man, an 8-year-old boy, and a 70-year-old man) developed shallowing of the anterior chamber and uveal effusion after blunt ocular injuries. After treatment with antibiotics (all three patients), corticosteroids (one patient), a mydriatic-cycloplegic solution (two patients), and antiglaucoma drugs (one patient), the shallowing and uveal effusion resolved. Because resolution occurred within two weeks in all three cases, surgical intervention was unnecessary. Both hypotony, which is common after nonpenetrating ocular injuries, and shallowing of the anterior chamber, which is rare, may result from localized uveal effusion that is clinically undetectable.