INTERESTING EYE NEWS & CLINICAL PEARLS

OphSource. doi:10.1016/j.ophtha.2009.06.058 In open-angle glaucoma with normal intraocular pressure, cerebral spinal fluid pressure is abnormally low, leading to an abnormally high trans-lamina cribrosa pressure difference. A low cerebral spinal fluid pressure in normal-intraocular pressure glaucoma may have the same effect as high intraocular pressure in patients with normal cerebrospinal fluid pressure.

Causes of hypochromia include Congenital Horner's syndrome Fuch's heterochomic iridocyclitis Causes of hyperchromia include: Nevus of Ota Siderosis Iris nevus or melanoma Unilateral prostaglandin use Sturge Weber syndrome

This is usually unilateral ocurring in people in their 20's or 30's, particularly females. The patient has a suddden onset of decreased vision associated with light flashes. There may be a mild APD and mild vitritis. There will be multiple white dots involving the posterior pole and mid-periophey, with teh macula spared and optic disc swelling. Sevceral weeks later the dots and disk swelling fades and central vision returns to normal with remaining foveal granularity and possibly light flashes continuing. 10% may relapse.

This typically affects people in their 20's or 30's. The patient presents with blurred vision, floaters, or flashes of light. There may be anterior uveitis w/ vitreous cells. Fundus examination reveals multiple yellow lesions at the posterior pole and periphery, arranged in clumps or linear streaks (Schlagel lines). 40% of these patients have CME. The borders can become pigmented. There may be visual field defects and enlarged blind spot. Sarcoid and PIC show similar fundus lesions. Sarcoid lesions are usualy more numerous in the inferior fundus. PIC does not have intraocular inflammation. Treatment is with systemic and periocular steroids. The disesae is recurrent and chronic and the prognosis is variable from good to poor.

Dovepress The travoprost/timolol combination produced mean IOP reductions from baseline of 35.3% to 38.5%, while the dorzolamide/timolol combination produced mean IOP reductions from baseline of 32.5% to 34.5%. Conclusions: The fixed combination travoprost 0.004%/timolol 0.5% dosed once daily in the morning demonstrated superior mean diurnal IOP-lowering efficacy compared to dorzolamide 2%/timolol 0.5% dosed twice daily in patients with ocular hypertension or open-angle glaucoma.

Serpiginous choroidopathy is bilateral albeit asymmetrical affecting people in their 30's to 50's. It affects men more than women and is associated with HLA-B7. It is chronic and episodic. The patient may experience blurred vision or metamorphopsia in one or both eyes. 50% of the eyes have vitritis with possible mild anterior uveitis. The lesions are yellowish, first appearing around the optic disc and then spread toward the macula. Choroidal and RPE atrophy then develops over time. Treatment may be disappointing. Some doctors use steroids, azathioprine, or cyclosporin in an effort to limit recurrence. 50-75% of patients developo vision loss. 25% develop choroidal neovascularization.

Punctate Inner Choroidopathy affects the eyes of mostly young, near-sighted women. The vision is blurred. Sometimes there are paracentral scotomas on visual field testing. The patient might see light flashes (photopsia). There is very little inflammation. The macula shows small white dots that eventually become pigmented scars. Choroidal neovascularization occurs in about 40% of patients. The other eye can become involved thereafter. Treatment options can be with argon laser photocoagulation with intravitreal steroids, systemic steroids, PDT, and possibly surgical excision of the neovascular membrane. Some patients can retain vision of 20/30 or better. You have to rule out multifocal choroiditis (similar but with inflammation), POHS (look for peripapillary atrophy), and myopic maculopathy (look for more extensive degeneration peripherally).