- Email: [email protected]
Presentation, natural history, and management of carotid cavernous aneurysms
venular diameters, or both. This study was based on the prospective population-based Rotterdam Study (1990 to 1993) and included 1900 participants (ⱖ55 years of age) of whom 739 persons had normal blood pressure (systolic ⬍120 mm Hg and diastolic ⬍80 mm Hg) and 1161 prehypertension (systolic 120 to 139 mm Hg or diastolic 80 to 89 mm Hg). For each participant, retinal arteriolar and venular diameters were measured on digitized images of one eye. After a mean follow-up of 6.6 years, 808 persons developed hypertension, defined as either systolic blood pressure ⬎140 mm Hg or diastolic blood pressure ⬎90 mm Hg or use of antihypertensive medication. Adjusted for age, gender, follow-up time, body mass index, smoking, diabetes mellitus, total and high-density lipoprotein cholesterol, C-reactive protein, and intima-media thickness, arteriolar narrowing was associated with an increased risk of hypertension (odds ratio per SD: 1.38; 95% CI, 1.23 to 1.55); for venular narrowing this was less striking (OR: 1.17; 95% CI, 1.04 to 1.32). Each SD decrease in the arteriolar: venular diameter ratio significantly increased the risk of hypertension by 24%. To examine the effect of baseline blood pressure, participants were stratified into those with “normal blood pressure” or “prehypertension.” Within each group, arteriolar narrowing was still related to incident hypertension. The authors conclude that both retinal arteriolar and venular narrowing may precede the development of systemic hypertension.—Valérie Biousse
The treated group had a higher proportion of neurological and visual complications than people who were not treated (2(2). ⫽ 25.26, P ⫽ .0003). The authors concluded that endovascular treatment of carotid cavernous aneurysms lead to higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The authors conclude that treatment should be considered only in cases of debilitating pain, visual loss from compressive optic neuropathy, diplopia in primary gaze, or in patients with risk factors for major complications such as preexisting coagulopathy or sphenoid sinus erosion.—Valérie Biousse *Hadas Stiebel-Kalish, MD, Neuro-Ophthalmology Service, Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel; e-mail: [email protected]
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Possible sources of neuroprotection following subretinal silicon chip implantation in RCS rats. Pardue MT,* Phillips MJ, Yin H, Fernandes A, Cheng Y, Chow AY, Ball SL. J Neural Eng 2005;2:S39 –S47.
R
stimulate existing neural circuits in diseased retinas in order to create a visual signal. Implantation of retinal prosthetics may create a neurotrophic environment that also leads to improvements in visual function. Possible sources of increased neuroprotective effects on the retina may arise from electrical activity generated by the prosthetic, mechanical injury attributable to surgical implantation, and/or presence of a chronic foreign body. In this study, three neuroprotective sources were evaluated by implanting Royal College of Surgeons (RCS) rates, a model of retinitis pigmentosa, with a subretinal implant at an early stage of photoreceptor degeneration. Treatment groups included rats implanted with active and inactive devices and sham-operated rats. These groups were compared with unoperated controls. Evaluation of retinal function throughout an 18-week post-implantation period demonstrated transient functional improvements in eyes implanted with an inactive device at 6, 12, and 14 weeks post-implantation. However, the number of photoreceptors located directly over or around the implant or sham incision was considerably increased in eyes implanted with an active or inactive device or sham-operated. These results indicate that in the RCS rat , localized neuroprotection of photoreceptors from mechanical injury or a chronic foreign body may provide similar results to subretinal electrical stimulation at the current output evaluated.—Hans E. Grossniklaus
*Paulus T. V. M. De Jong, The Netherlands Ophthalmic Research Institute, KNAW, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands; e-mail: [email protected]
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Presentation, natural history, and management of carotid cavernous aneurysms. Stiebel-Kalish H,* Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ. Neurosurgery 2005;57:850 – 857.
T
HIS STUDY PRESENTS THE NEURO-OPHTHALMIC CHAR-
acteristics of a large cohort of carotid cavernous aneurysms (CCA). The authors retrospectively reviewed 185 patients with 206 CCAs examined between 1980 and 2001. Patients’ symptoms and findings at presentation and after treatment were recorded. The effect of treatment on outcome and on complication rate was analyzed using the chi test, multivariate analysis of covariance, model-selection log-linear analysis, and multinomial logistic regression. Long-term follow-up was available for 189 of 206 CCAs. Seventy-four CCAs underwent treatment (endovascular, 67 [91%]; surgical treatment, six [9%]), and 115 were followed for an average of 4 years, two of which required later treatment. Treatment reduced the incidence and severity of pain, even after adjusting for the severity of initial pain (F(1,192 ⫽ 9.59, P ⫽ .002). Treatment did not significantly affect the patient’s final diplopia after adjusting for their initial diplopia (F(1,182 ⫽ 2.01, P ⫽ .158). 602
AMERICAN JOURNAL
ETINAL PROSTHETIC IMPLANTS ARE DESIGNED TO
*M. T. Pardue, Atlanta VA Medical Center, Research Service (151 Oph), 1670 Clairmont Road, Decatur, GA 300033. OF
OPHTHALMOLOGY
MARCH 2006
The treated group had a higher proportion of neurological and visual complications than people who were not treated (2(2). ⫽ 25.26, P ⫽ .0003). The authors concluded that endovascular treatment of carotid cavernous aneurysms lead to higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The authors conclude that treatment should be considered only in cases of debilitating pain, visual loss from compressive optic neuropathy, diplopia in primary gaze, or in patients with risk factors for major complications such as preexisting coagulopathy or sphenoid sinus erosion.—Valérie Biousse *Hadas Stiebel-Kalish, MD, Neuro-Ophthalmology Service, Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel; e-mail: [email protected]
●
Possible sources of neuroprotection following subretinal silicon chip implantation in RCS rats. Pardue MT,* Phillips MJ, Yin H, Fernandes A, Cheng Y, Chow AY, Ball SL. J Neural Eng 2005;2:S39 –S47.
R
stimulate existing neural circuits in diseased retinas in order to create a visual signal. Implantation of retinal prosthetics may create a neurotrophic environment that also leads to improvements in visual function. Possible sources of increased neuroprotective effects on the retina may arise from electrical activity generated by the prosthetic, mechanical injury attributable to surgical implantation, and/or presence of a chronic foreign body. In this study, three neuroprotective sources were evaluated by implanting Royal College of Surgeons (RCS) rates, a model of retinitis pigmentosa, with a subretinal implant at an early stage of photoreceptor degeneration. Treatment groups included rats implanted with active and inactive devices and sham-operated rats. These groups were compared with unoperated controls. Evaluation of retinal function throughout an 18-week post-implantation period demonstrated transient functional improvements in eyes implanted with an inactive device at 6, 12, and 14 weeks post-implantation. However, the number of photoreceptors located directly over or around the implant or sham incision was considerably increased in eyes implanted with an active or inactive device or sham-operated. These results indicate that in the RCS rat , localized neuroprotection of photoreceptors from mechanical injury or a chronic foreign body may provide similar results to subretinal electrical stimulation at the current output evaluated.—Hans E. Grossniklaus
*Paulus T. V. M. De Jong, The Netherlands Ophthalmic Research Institute, KNAW, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands; e-mail: [email protected]
●
Presentation, natural history, and management of carotid cavernous aneurysms. Stiebel-Kalish H,* Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ. Neurosurgery 2005;57:850 – 857.
T
HIS STUDY PRESENTS THE NEURO-OPHTHALMIC CHAR-
acteristics of a large cohort of carotid cavernous aneurysms (CCA). The authors retrospectively reviewed 185 patients with 206 CCAs examined between 1980 and 2001. Patients’ symptoms and findings at presentation and after treatment were recorded. The effect of treatment on outcome and on complication rate was analyzed using the chi test, multivariate analysis of covariance, model-selection log-linear analysis, and multinomial logistic regression. Long-term follow-up was available for 189 of 206 CCAs. Seventy-four CCAs underwent treatment (endovascular, 67 [91%]; surgical treatment, six [9%]), and 115 were followed for an average of 4 years, two of which required later treatment. Treatment reduced the incidence and severity of pain, even after adjusting for the severity of initial pain (F(1,192 ⫽ 9.59, P ⫽ .002). Treatment did not significantly affect the patient’s final diplopia after adjusting for their initial diplopia (F(1,182 ⫽ 2.01, P ⫽ .158). 602
AMERICAN JOURNAL
ETINAL PROSTHETIC IMPLANTS ARE DESIGNED TO
*M. T. Pardue, Atlanta VA Medical Center, Research Service (151 Oph), 1670 Clairmont Road, Decatur, GA 300033. OF
OPHTHALMOLOGY
MARCH 2006