- Email: [email protected]
Poster 44 - Pseudo–Foster Kennedy Syndrome and Anterior Ischemic Optic Neuropathy
POSTER 43 Foveal Neovascularization in a Diabetic Patient Maryke Neiberg, O.D. and J. Harris Levy, M.D. Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: Neovascularization at the optic disk or elsewhere in the retina is a common finding in diabetic retinopathy. Neovascularization at the fovea, however, is rare and has been described in fewer than 10 cases in the literature. The fovea ordinarily has a natural resistance to the formation of neovascular vessels and ischemic complications such as cotton-wool spots. Case Report: We present a case of a 42-year-old woman with longstanding insulin-dependentdiabetes mellitus and proliferative retinopathy, followed over a course of 54 months. The patient first manifested neovascularization elsewhere and subhyaloid hemorrhage O.D., and neovascularization elsewhere O.S. A typical white lesion, previously described in the literature, similar in appearance to a cotton-wool spot, preceded the foveal neovascularization.After pan-retinal photocoagulation (PRP),the acuities were 20140 O.D. and 20130 O.S., with regression of bilateral rubeosis and resolution of the subhyaloid hemorrhage O.D. A fibrotic scar in the same eye and an epiretinal membrane ensued, resulting in 20180 acuity O.D. Foveal neovascularization was noted after the membrane peel, and subsequently involuted with additional PRP. Complications of a "macula-off"retinal detachment later resulted in acuity of 201400. At last visit, clinically significant macular edema had developed in the patient. The acuity in the left eye has remained stable. Conclusion: Foveal neovascularization is a rare complication of proliferative diabetic retinopathy. It is often preceded by a white cotton-wool spot traversed by fine neovascular vessels. Good visual acuity is usually maintained; however, the lesion might show increased size or permeability over time and should be followed carefully.
POSTER 44 Pseudo-Foster Kennedy Syndrome and Anterior Ischemic Optic Neuropathy Christine Corella, O.D. Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: A 55-year-old man came in for an examination following a painless loss of vision O.S. five days earlier. Medical history was positive for high cholesterol and osteroarthritis. Ocular history was remarkable for an anterior ischemic optic neuropathy O.D. 10 years earlier. Methods: Entering visual acuities were 20170 + O.D. and 20140- O.S., with no improvement on pinhole. There was an afferent pupillary defect O.S. Anterior segment evaluation was unremarkable. Dilated fundus examination (DFE)revealed superior optic nerve pallor O.S., and optic nerve congestion O.S. Multiple flame-shaped hemorrhages surrounded the optic nerve O.S. (photographs were taken). The patient was given a STAT referral to his PCP for blood work to rule out arteritic causes of anterior ischemic optic neuropathy. OPTOMETRY
Results: On two week followup, visual acuities were 20140 O.D., but down to 131200 O.S. A 30-2 Sita-Fast visualfield testing revealed a stable inferior arcuate defect O.D., and a significant generalized reduction in sensitivity O.S. Kinetic visual-field testing (III4E) revealed some constriction of the inferior field O.D., and significant constriction of the field O.S. DFE revealed persistent swelling of the optic nerve O.S., although some mild improvement was noted. Blood testing revealed an ESR of 4 mmlhr and a cardiac CRP of 4.35 mglL. LDL levels were elevated at 131 mg1dL. Conclusions: The incidence of non-arteritic anterior ischemic optic neuropathy occurring in the opposite eye is between 30% and 50%. Some studies have shown that the use of aspirin can help reduce the incidence. Pseudo-Foster Kennedy syndrome is defined by the combined appearance of optic disk pallor in one eye, and optic nerve head edema in the opposite eye. Over a period of a few months, the optic nerve head swelling will subside and pallor will ensue.
POSTER 45 A Case of Acute Hemorrhagic Conjunctivitis Christine Corella, 0 .D. Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: A 31-year-old woman came in for an emergency eye examination. 'Ilvo days earlier, she was transported by ambulance to the ER for evaluation of a painful red eye O.S. She was diagnosed with a corneal abrasion and treated with Tobramycin O.S. A reaction to the Tobramycin developed and she was returned to the E.R., where she was treated with Ciloxin O.S. On Day 3, when she came to our clinic, she reported bilateral painful red eyes. Medical and ocular history was unremarkable, except for alcoholism. Visual acuities without habitual correction were 201200 O.D. and 201400 O.S. She would not cooperate to assess pinhole visual acuity. Both eyes had moderate lid swelling, petechial lid hemorrhages, watery discharge with a mild mucous component, conjunctival injection with scattered petechial hemorrhages, and negative corneal infiltration. The left eye had a diffuse 360" subconjunctival hemorrhage, a central corneal abrasion covering 50% of the cornea, and a mild anterior chamber reaction. (Photographs were taken. She had palpable pre-auricular and submandibular nodes on the left side.) Methods: Differentials included hyperacute gonoccocal conjunctivitis, EKC, pharyngoconjunctival fever, adult inclusion conjunctivitis, and acute hemorrhagic conjunctivitis. After consultation with an ophthalmologist, the patient was diagnosed with acute hemorrhagic conjunctivitis (AHC).She was given prophylactic treatment for the corneal abrasion with Zymar O.S., along with other palliative treatment. Results: Acute hemorrhagic conjunctivitis (AHC),also known as Apollo disease, was introduced into the Western hemisphere in 1981. AHC is caused by a Coxsackie (A24)or Enterovirus (E70),and usually affects tropical coastal cities. Epidemics are common in developing countries, or areas in which hygiene is poor.
VOLUME 76lNUMBER 611UNE 2005
POSTER 44 Pseudo-Foster Kennedy Syndrome and Anterior Ischemic Optic Neuropathy Christine Corella, O.D. Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: A 55-year-old man came in for an examination following a painless loss of vision O.S. five days earlier. Medical history was positive for high cholesterol and osteroarthritis. Ocular history was remarkable for an anterior ischemic optic neuropathy O.D. 10 years earlier. Methods: Entering visual acuities were 20170 + O.D. and 20140- O.S., with no improvement on pinhole. There was an afferent pupillary defect O.S. Anterior segment evaluation was unremarkable. Dilated fundus examination (DFE)revealed superior optic nerve pallor O.S., and optic nerve congestion O.S. Multiple flame-shaped hemorrhages surrounded the optic nerve O.S. (photographs were taken). The patient was given a STAT referral to his PCP for blood work to rule out arteritic causes of anterior ischemic optic neuropathy. OPTOMETRY
Results: On two week followup, visual acuities were 20140 O.D., but down to 131200 O.S. A 30-2 Sita-Fast visualfield testing revealed a stable inferior arcuate defect O.D., and a significant generalized reduction in sensitivity O.S. Kinetic visual-field testing (III4E) revealed some constriction of the inferior field O.D., and significant constriction of the field O.S. DFE revealed persistent swelling of the optic nerve O.S., although some mild improvement was noted. Blood testing revealed an ESR of 4 mmlhr and a cardiac CRP of 4.35 mglL. LDL levels were elevated at 131 mg1dL. Conclusions: The incidence of non-arteritic anterior ischemic optic neuropathy occurring in the opposite eye is between 30% and 50%. Some studies have shown that the use of aspirin can help reduce the incidence. Pseudo-Foster Kennedy syndrome is defined by the combined appearance of optic disk pallor in one eye, and optic nerve head edema in the opposite eye. Over a period of a few months, the optic nerve head swelling will subside and pallor will ensue.
POSTER 45 A Case of Acute Hemorrhagic Conjunctivitis Christine Corella, 0 .D. Nova Southeastern University, College of Optometry, 3200 South University Drive, Ft. Lauderdale, Florida 33328 Background: A 31-year-old woman came in for an emergency eye examination. 'Ilvo days earlier, she was transported by ambulance to the ER for evaluation of a painful red eye O.S. She was diagnosed with a corneal abrasion and treated with Tobramycin O.S. A reaction to the Tobramycin developed and she was returned to the E.R., where she was treated with Ciloxin O.S. On Day 3, when she came to our clinic, she reported bilateral painful red eyes. Medical and ocular history was unremarkable, except for alcoholism. Visual acuities without habitual correction were 201200 O.D. and 201400 O.S. She would not cooperate to assess pinhole visual acuity. Both eyes had moderate lid swelling, petechial lid hemorrhages, watery discharge with a mild mucous component, conjunctival injection with scattered petechial hemorrhages, and negative corneal infiltration. The left eye had a diffuse 360" subconjunctival hemorrhage, a central corneal abrasion covering 50% of the cornea, and a mild anterior chamber reaction. (Photographs were taken. She had palpable pre-auricular and submandibular nodes on the left side.) Methods: Differentials included hyperacute gonoccocal conjunctivitis, EKC, pharyngoconjunctival fever, adult inclusion conjunctivitis, and acute hemorrhagic conjunctivitis. After consultation with an ophthalmologist, the patient was diagnosed with acute hemorrhagic conjunctivitis (AHC).She was given prophylactic treatment for the corneal abrasion with Zymar O.S., along with other palliative treatment. Results: Acute hemorrhagic conjunctivitis (AHC),also known as Apollo disease, was introduced into the Western hemisphere in 1981. AHC is caused by a Coxsackie (A24)or Enterovirus (E70),and usually affects tropical coastal cities. Epidemics are common in developing countries, or areas in which hygiene is poor.
VOLUME 76lNUMBER 611UNE 2005