Ophthalmology Update - Cleveland Clinic

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i n v e s t i g a t i O n s For more information, contact Elias I. Traboulsi, M.D., at traboue@ccf.org. NEI-Sponsored Study Evaluating Role of Primary IOL Continued from page 23 that latter observation is consistent with previous studies of infants who have undergone surgery for congenital cataracts without iOl implantation,” dr. traboulsi says. however, he notes the findings from his review must be considered against the limitations of the study, which was retrospective and not randomized. “the safety and benefits of primary iOl implantation in infants need to be confirmed in the ongoing, prospective iats study,” dr. traboulsi says. // O p h t h a l m O l O g y U p d a t e s p e c i a l e d i t i O n 2 0 0 6
Case Study: Five-Month-Old Boy Presents with Incomitant Esotropia By Evelyn Fu, M.D., and Elias I. Traboulsi, M.D. a 5-month-old boy with no significant ocular history presented to cleveland clinic cole eye institute with esotropia of the right eye for 1 month. no other visual symptoms were noted. his medical history revealed a recent episode of otitis media treated with antibiotic eardrops. he was born at full term via vaginal delivery without perinatal complications. review of systems is significant for episodic nonprojectile vomiting with increasing frequency that began one week prior to presentation. Family history is positive for hypertension and aortic dissection in paternal great-grandfather and grandfather. On examination, the boy appears well nourished and developed. he fixes and follows well with both eyes. there is a moderate esotropia of the right eye in primary gaze that increases on right gaze and decreases on left gaze. the degree of esotropia is equal at distance and near. there is severe limitation in abduction of the right eye beyond midline. globe retraction is not noted in adduction. the pupils are equal, round and reactive to light without an afferent defect. slit-lamp examination and dilated ophthalmoscopy are normal in both eyes. the remaining medical and neurological examination is normal. Differential Diagnosis incomitant esotropia describes an inward deviation of the eye that varies in different fields of gaze. it results from a variety of etiologies including sixth-nerve palsy, type i duane syndrome, divergence insufficiency and orbital blowout fracture with restriction of the lateral rectus muscle. patients with type i duane syndrome have poor abduction with globe retraction in adduction. divergence insufficiency is characterized by esotropia that is greater at distance than at near. Further, the deviation does not change with vertical or horizontal gaze. Our patient’s symptoms and signs are most consistent with an isolated sixth-nerve palsy. Diagnosis the most common causes of sixth-nerve palsy in children are trauma and intracranial lesions. 1, 2 in the absence of trauma, a full neurological evaluation including neuroimaging is recommended. On head ct, a 2.6-cm hyperdense mass was noted in the right middle fossa with remodeling of the adjacent FIGURE 1 FIGURE 2 sphenoid body and greater wing (Figure 1). cta and mri demonstrated characteristics of a giant thrombosed aneurysm of the cavernous internal carotid artery, without compression of the optic nerve or chiasm (Figure 2). the diagnosis was a giant intracavernous carotid artery aneurysm (iccaa). Discussion iccaas are extremely rare in the pediatric population. 3, 4 information regarding the natural history, pathogenesis, radiographic features, treatment and prognosis are derived from large case series of adult patients. 5, 6, 7 symptoms from iccaa can be divided Continued on page 26 i n v e s t i g a t i O n s Figure 1: CT image of a 5-month-old boy with incomitant esotropia. Figure 2: MR image of a 5-month-old boy with incomitant esotropia. c O l e e y e i n s t i t U t e c l e v e l a n d c l i n i c . O r g / e y e //
Page 1 and 2: Cleveland Clinic Cole Eye Institute
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Page 7 and 8: useful prognostic tools and (2) the
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Page 13 and 14: CSNB Mouse Models Provide Valuable
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Page 23 and 24: lens. that technique has also been
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Page 31 and 32: however, a few months later she ret
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Ophthalmology Update - Cleveland Clinic

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