ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This review presents highlights and updates from of the most significant clinical trials in neuro-ophthalmology to date, the Optic Neuritis Treatment Trial, the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study, and the Ischemic Optic Neuropathy Decompression Trial. The quality of evidence for treatment efficacy from these trials and other recent investigations of giant cell arteritis and idiopathic intracranial hypertension is classified herein according to published criteria based on sample size and study design.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Visual loss caused by giant cell arteritis is a medical emergency that requires prompt recognition and treatment with systemic corticosteroids. A delay in diagnosis can lead to devastating ophthalmic and systemic complications. Recent advances in genetic and immunocytochemical research techniques have led to greater understanding of the underlying pathomechanisms of giant cell arteritis. Giant cell arteritis is a systemic condition with a strong predilection for the ocular vasculature. Visual symptoms are often the presenting manifestation of the disease, placing the ophthalmologist in a critical position for early diagnosis and treatment. Maintenance of a high clinical suspicion in the appropriate clinical setting is important in establishing an early diagnosis. Because of the complex nature of the disease process, many cases may be a therapeutic challenge requiring prolonged immunosuppression.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Optic neuritis and multiple sclerosis (MS) are common causes of visual and neurologic dysfunction in young adults. Advances in magnetic resonance imaging, molecular genetics, and neuroimmunology have increased our understanding of the pathophysiology underlying both disorders. Corticosteroids remain the mainstay of treatment of optic neuritis, but alternate dosages and routes of administration are undergoing investigation. The available therapies for MS have expanded, and there is evidence that early intervention is beneficial. Treatments for MS show sustained efficacy, but are not curative, and adjunctive treatments may prove valuable in patients with progressive visual and neurologic disability.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Strabismus surgery may restore limited binocular function and improve cosmesis in patients with paralytic strabismus. Evaluation of the amount of residual function of the affected extraocular muscles is essential to determine which surgical procedure will yield the best results. Standard muscle resection techniques are effective for patients who have paretic extraocular muscles with residual function. Muscle transposition procedures are indicated for patients with total paralysis of an extraocular muscle. Autogenous and alloplastic materials may be required to fix the eye in primary position in patients with total paralysis of multiple extraocular muscles. This article discusses the recent literature regarding the evaluation and management of patients with paralytic strabismus. Current concepts regarding extraocular muscle transposition and the use of autogenous materials are emphasized.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Botulinum toxin produces a temporary chemical denervation, which initially was used to reduce the diplopia associated with paralytic strabismus. Subsequently, the drug was found to be effective in the management of dystonias, including hemifacial spasm and blepharospasm. More recently, there is evidence that botulinum toxin may lessen the pain associated with some movement disorders, tension headache, and migraine. The effect of botulinum toxin in temporary, but the therapeutic benefit usually is maintained even after repeated injections. The form of botulinum toxin used in clinical practice is the A serotype. Other serotypes may have a therapeutic role in the future. The mode of action and the clinical experience of botulinum toxin in neuro-ophthalmology is discussed.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although the annual incidence of primary and secondary syphilis has dropped to the lowest rate recorded, syphilis remains an important cause of ocular disease. Uveitis is the most common ocular manifestation of syphilis in both HIV-positive and HIV-negative patients, and the diagnosis should prompt an analysis of the cerebrospinal fluid to exclude associated neurosyphilis. Newer modalities such as enzyme immunoassays and genomic amplification using the polymerase chain reaction may prove to be useful techniques to detectTreponema pallidumin intraocular specimens. The preferred treatment for all stages of syphilis remains parenteral penicillin G, although the preparation, dose, route of administration, and duration of therapy are dictated by the stage of disease and various host factors. All patients diagnosed with ocular syphilis should be tested for HIV, because the presence of a primary genital chancre increases the risk of acquiring or transmitting HIV, and because risk factors for the two diseases are similar.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Presumed ocular histoplasmosis involves the classic triad of discrete atrophic choroidal scars in the macula or midperiphery known as histo spots, peripapillary atrophy, and choroidal neovascularization, which leads to severe loss of central vision. The histo spots from which the choroidal neovascularization develop do not show active inflammation but do represent focal defects in Bruch membrane that could facilitate development of choroidal neovascularization. The macular photocoagulation studies unequivocally show the benefit of photocoagulation compared with observation in reducing the risk of vision loss in patients with presumed ocular histoplasmosis, well defined extrafoveal or juxtafoveal choroidal neovascularization, and choroidal neovascularization in the peripapillary area. However, laser treatment itself causes an absolute scotoma correlating with the site of the laser photocoagulation scar, and subfoveal choroidal neovascularization is not amenable to laser photocoagulation because this would cause a blinding central scotoma. Consequently, other treatments have been sought. The Verteporfin in Ocular Histoplasmosis study evaluated photodynamic therapy for subfoveal choroidal neovascularization caused by presumed ocular histoplasmosis and demonstrated stabilization of the choroidal neovascularization and visual acuity benefit. In addition to photodynamic therapy, antiangiogenic compounds are being developed for choroidal neovascularization caused by age-related macular degeneration, and these agents will likely be of benefit in presumed ocular histoplasmosis associated choroidal neovascularization. Finally, submacular surgery for the removal of subfoveal choroidal neovascularization has promising results. The results of these research efforts will produce more effective therapeutic approaches in the future.

ISSN:1040-8738    

出版商:OVID    

年代:2001

数据来源: OVID