摘要:

Purpose of reviewFollowing technological advances in imaging and dose planning made in the past decade, gamma knife radiosurgery has become more and more an established treatment for a wide range of indications of interest and import to the neuro-ophthalmology community. These areas include cavernous sinus lesions and sellar lesions (for which radiosurgery can be offered as adjuvant or in certain cases as primary treatment), cavernous sinus fistulae, parasellar syndromes, and pituitary tumors.Recent findingsOccurrence of radiation-induced cranial nerve deficits and radiation-induced optic neuropathy are infrequent following radiosurgery to these areas, and perhaps radiation-induced necrosis is less prevalent than in conventional radio therapeutic interventions.SummaryGamma knife radiosurgery remains a compelling treatment for lesions of the cavernous sinus, pineal, and sellar regions and offers increasing applicability for ocular conditions such as uveal melanoma and glaucoma.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism.Recent findingsAlthough a number of modalities have been used to assess visual function in patients with chiasmal disorders, perimetry remains the most effective means of detecting and following the visual deficit.SummaryMost chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewGiant cell arteritis (GCA) is the most common form of systemic vasculitis that causes visual loss in the elderly. This review highlights current concepts dealing with the diagnosis, treatment, and visual prognosis of patients with GCA.Recent findingsRecent evidence suggests that recovery of visual function in patients with visual loss from GCA is poor. An algorithm has been constructed to assist clinicians in the evaluation and management of patients suspected of having GCA.SummaryDespite a number of new adjunctive agents, corticosteroids remain the standard treatment in patients with GCA.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewSeveral therapies have potential neuro-ophthalmic or ophthalmic complications. We reviewed the recent literature for relevant therapies that affect ocular function. In this review, we discuss a variety of toxic effects of antiepileptic drugs, endocrine drugs, and miscellaneous therapies (intravitreal silicone oil and TNF-&agr; inhibitors).Recent findingsThe pathogenesis of these side effects is quite heterogeneous affecting visual sensory function at the levels of the ciliary body, retina, optic nerve and chiasm, and central visual pathways.SummaryAppropriate management requires prompt recognition of these associations. Practitioners should be familiar with these neuro-ophthalmic manifestations because they may present in the course of daily practice.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewMigraine is a common disorder with visual and neurologic manifestations. Many patients present to ophthalmologists without a previous diagnosis of migraine. It is therefore essential for the ophthalmologist to have a good understanding of migraine to appropriately help these patients. Neurologic syndromes with migraine and retinopathy are well known. Here again, the ophthalmologist may play a role in establishing the correct diagnosis.Recent findingsFor long the initial changes during a migraine attack have been shown to occur in the occipital cortex. In the recent years, the understanding of migraine has advanced with the availability of functional neuroimaging. A possible role of brainstem structures in the initiation of migraine attacks has been proposed based on functional magnetic resonance imaging blood oxygenation level-dependent signals. Activation of brainstem structures preceded activation of occipital cortex. Our understanding of cortical spreading depression is also advancing. Using multiwavelength optical intrinsic imaging, cortical spreading depression has been shown to have a triphasic response in rats. For the first time it has been shown that the cortical spreading depression activated the trigeminovascular system, which is followed by a series of cortical meningeal and brainstem events that cause the migraine headache. Sildenafil has been shown to induce migraine attack without dilation of cerebral blood vessels, further confirming that Wolf's vasogenic theory may not be true. Several loci for migraine have been identified in recent years. A new locus for migraine with and without aura has been identified on chromosome 6, a locus for migraine without aura to chromosome 14, and a locus for migraine with aura on chromosome 4.SummaryOur understanding of migraine is rapidly evolving with functional neuroimaging. There are several unanswered questions. In this article, we will review the epidemiology, genetics, and clinical features of various forms of migraine with emphasis on ocular migraine, pathogenesis, and briefly the management of migraine.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewEfforts to discover modalities and pathophysiologies that might afford successful neurorescue, neurorestoration, and neuroprotection of cells of the central nervous system have focused on processes that affect the central nervous system proper, that is, the brain. Often overlooked in the search for neural protection is the fact that the mammalian optic nerve behaves in many ways as an integral part of the central nervous system. As such, the eye—the optic nerve and retina—affords an ideal clinical model for neuroprotection and neuroprotective agents. Glaucomatous optic neuropathy is the most prevalent of all adult optic neuropathies, and offers an ideal primate and lower mammalian animal model for investigations of neuroprotection.Recent findingsThis is especially compelling because while recent studies in glaucoma have shown reduction of intraocular pressure (IOP) to be an effective modality in the treatment of glaucomatous optic neuropathy, not all patients respond to or can achieve meaningful IOP reductions. Therefore much attention has now been focused on neuroprotection as a strategy in therapies for glaucomatous optic neuropathy as a means of preserving retinal ganglion cells and their axonal projections.SummaryThis review discusses the latest studies on various mechanisms of neuroprotection in the treatment of glaucomatous optic neuropathy.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Horner syndrome refers to the constellation of signs resulting from the interruption of sympathetic innervation to the eye and ocular adnexae. Classically, the clinical findings include a triad of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis. The history, additional clinical examination features, and pharmacologic testing may help localize the lesion and suggest an etiology. An appropriate evaluation of Horner syndrome and a timely elucidation of the etiology may allow for a potentially life-saving intervention.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo discuss the current standard in diagnosis and treatment of pseudotumor cerebri (PTC), the syndrome of increased intracranial pressure without a brain tumor. Since PTC is a diagnosis of exclusion, the differential diagnostic work-up is of special importance.Recent findingsModern imaging techniques have facilitated the differential diagnosis of PTC. Various therapeutic options are available to prevent irreversible visual loss. New treatment modalities are being explored, but the standard therapy has undergone little change in the past years.SummaryPTC, a potentially blinding disease, most commonly manifests with headache and slightly blurred vision due to papilledema. This review seeks to present a methodical approach to its diagnosis and treatment.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewAs the prevalence of diabetes mellitus increases globally, recognition of the atypical manifestations of diabetic retinopathy will become increasingly important.Recent findingsIn addition to the inherent variability in the spectrum of diabetic retinopathy, coexisting systemic or ocular conditions can dramatically alter the retinal manifestations of diabetes mellitus in any given patient.SummaryWe review here the clinical features and treatment implications associated with the atypical manifestations of diabetic retinopathy.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo review current knowledge about the pathogenesis, clinical presentation, and treatment of HLA-B27–associated uveitis, which is the most commonly identified cause of uveitis in community-based practice and an important cause of ocular morbidity.Recent findingsSignificant advances have been made in understanding the pathogenesis of HLA-B27–associated ocular and systemic disease, especially with regard to the genetic underpinning of these diseases. Increasing attention has also been focused on the use of alternative therapies in the treatment of HLA-B27–associated uveitis, with special attention to sulfa class antibiotics, historically have been used to treat the articular manifestations of the spondyloarthritides, and newer drugs that inhibit tumor necrosis factor-&agr;.SummaryThe next several years promise to yield exciting new advances in understanding of the genetic epidemiology and treatment of HLA-B27–associated uveitis.

ISSN:1040-8738    

出版商:OVID    

年代:2003

数据来源: OVID