Table of Contents - WOC 2012

PO-NEO-18
Myastenia Gravis: 2 Cases Report
Silva Ana (1) , Braz Filipe (1) , Colaço Luisa (1) , Fonseca Ana (2) , Campos Fatima
(2)
1. Instituto de Oftalmologia Dr Gama Pinto
2. Hospital de Santa Maria
Purpose: Myasthenia gravis (MG) is a disorder of neuromuscular transmission
characterized by weakness and fatigability of skeletal muscles. Usually
appears after the third decade of life and is more common in females. Two
major clinical forms of MG are distinguished, ocular and generalized MG.
Ocular involvement occurs in 90% of cases. In MG there are high levels of
autoantibodies against acetylcholine receptors (AChR), leading to a decreased
number of functioning receptors and weakened muscle strength. The aim is to
present two clinical cases with different forms of MG.
Methods: Case Study 1 - man, 67 years old, right eyelid ptosis, progressive
dysphagia to solids and liquids, dysphonia and tiredness for small efforts. Case
Study 2 -man, 58 years old, ptosis and diplopia. We performed blood screening
and thoracic CT.
Results:Case 1 - high AChR; Electromyography positive. CT chest, thyroid
function tests and antinuclear antibodies (ANA) unchanged. Case 2 - AChR,
chest CT, thyroid function tests and ANA unchanged.
Conclusion: Dyspnea, dysphonia and dysphagia are symptoms that suggest
severe generalized myasthenia and may endanger the patient›s life, requiring
urgent neurologic examination. The ocular MG has a more benign course in
which therapeutic interventions are needed to neutralize his diplopia.
PO-NEO-19
Selection of cases for optic nerve sheath decompression in
idiopathic intracranial hypertension( IIH)
Elmatbouly Saber Essam (1) , Gabaly Habeeb Haneen (2)
1. Professor of ophthalmology & neuroophthalmology Banha University
2. Ophthalmology Department. Emek Medical Center, Neuro-ophthalmology
purpose Evaluate factors affecting success of optic nerve sheath decompression
, to save the visual functions in both eyes Method 82 patients aged 19-50 years
old having IIH failed to respond to medical treatment with deterioration of their
visual functions , were selected for ONSD either to one eye or needed surgery
for the other eye Followup ranged from fourteen months to five years Results
MRI imaging for the early treated cases revealed distention and ballooning of
optic nerve sheath, as the duration of papilledema increases the distention
decreases During surgery distention was apparent in early treated cases with
marked gush of CSF on opening the sheath , also subarachnoid trabeculations
were opened to facilitate flow of CSF Early treated cases resumed visual
functions and resolved papilledema in both eyes As the duration of papilledema
increases there is a need to do surgery for both eyes In chronic papilledema
the results of surgery become poor Conclusion If medical treatment failed to
resolve papilledema , surgical decision must be taken either to one eye or to
both eyes according to effect of surgery on one eye , duration of papilledema ,
optic disc appearance ,and MRI
PO-NEO-20
Non-Arteritic Anterior Ischemic Optic Neuropathy with Inferior
Altitudinal Field Defect in a Young Case of Secondary Polycythemia
Najafi Ahmad (1)
1. Department of Ophthalmology, Faculty of Medicine, University Malaya
A 31 years old man presented with sudden onset of painless non-progressive
complete loss of vision inferiorly in OD. He had experienced same problem
transiently for the past 2 years, with complete recovery following each episode.
He had a history of valvular heart disease in childhood, for which he had
undergone open heart surgery in 1997.There was positive history of heavy
smoking (30 pack-year), with no history of IV drug abuse. Visual acuity was
6/9 in OD and 6/6 in OS. Relative Afferent Pupilary Defect was present in
OD. Pale optic disc superiorly, with attenuation of both arteries and veins were
noted, with Cup-Disc ratio of 0.7 in OD and 0.6 in OS. Humphry visual field
showed right inferior altitudinal field defect sparing the macula. FFA showed
delayed filling of superior retinal artery and vein.ECG was normal sinus rhythm.
Except for hemoglobin level of 18.6 gr/l, the rest of blood tests were normal.
Echocardiography showed neither clot forming site nor any vegetation in the
heart. With the diagnosis of Non-Arteritic Anterior Ischemic Optic Neuropathy,
he was counselled regarding cessation of smoking as the only modifiable risk
factor in his hyper viscosity state, and was referred for an internist consult.
WOC2012 Abstract Book
PO-NEO-21
Idiopathic intracranial hypertension among pediatric patients, at
King Hussein Medical Centre
Al-Eajailat Suha (1) , Al-Madani Mosa (1) , Shaban Reham (1) , Asfour Wafa (1)
1. King Hussein Medical Centre, Royal Medical Services
Idiopathic intrcranial hypertension in the pediatric population occurs less
frequently than the adult population, and the clincal features differ from the
disease in adults in many ways.Children with IIH should be kept under close
monitoring and evaluation of visual acuity,visual fields,colour vision,pupillary
function and optic disc examination.Prompt diagnosis and treatment is very
essential for children can sustain visual loss despite treatment.The goal of the
treatment is to relieve symptoms and preserve vision by lowering intracranial
pressure using medical and surgical modalities.
PO-NEO-22
A case of spontaneous carotid cavernous fistula presenting with
proptosis
Berk Ergun Sule (1) , Ugurlu Nagihan (1) , Yulek Fatma (1) , Ergun Onur (2) , Cagil
Nurullah (3)
1. Ataturk Training and Research Hospital, Department of Ophthalmology
2. Sincan State Hospital, Department of Radiology
3. Yildirim Beyazit University, Department of Ophthalmology
Purpose:To present a case of spontaneous carotid cavernous fistula (CCF)
presenting with proptosis.
Methods:A 67 year old woman presented with a 1 week history of proptosis in
the left eye. Ocular examination revealed a visual acuity of 0,05(Snellen),
conjunctival chemosis, dilated episcleral vessels and restriction of extraocular
movement on the left eye. Exophthalmometry showed 7mm difference
between the eyes.
Results:Computerized tomography and magnetic resonance imaging showed
enlarged cavernous sinus, increased extraocular muscle size, dilated superior
ophthalmic vein on the left. Radiological findings suggested the diagnosis of
CCF and cerebral angiography confirmed presence of direct and low flow
CCF. Intermittent external manual compression of the cervical carotid artery
is recommended. After 2 weeks, exophthalmometry showed 3mm difference.
Conclusion:CCF is an abnormal communication between the cavernous sinus
and the carotid arterial system. It is divided into two categories, direct and
indirect. Direct fistulas are usually related to a trauma. Spontaneous, lowflow
fistulas are usually associated with atherosclerosis, hypertension and
collagen vascular disease. These patients may present with conjunctival
chemosis, proptosis, ophthalmoplegia and bruits. It must be differentiated
from orbital pseudotumor, orbital cellulitis or thyroid eye disease. Based on
patient›s symptoms, the treatment may be observation or neuro-radiological
intervention.
PO-NEO-23
Horner syndrome adquired by second cavum tumor
Carmona Hernandez Maravillas (1) , Alfaro Juarez Ana (1) , Rodrigo Morales
Esther (1) , Perez-Roca Fernando (2) , Montoro Moreno Rosa (1)
1. Hospital Virgen de las Nieves
2. Hospital La Inmaculada
Objective To show the importance of an exhaustive differential diagnosis in
Horner syndrome (HS) Methods We present a clinical case of a 13 years old
patient with history of acute lymphoblastic leukemia (ALL) two years before that
consults for peripheral facial palsy and anisocoria, with no findings indicating
relapse of ALL. Oftalmological exploration only shows 2 mm ptosis in left eye
accompanied by peripheral facial palsy. The anisocoria was greater in scotopic
conditions. The diagnosis of HS in this patient was confirmed by instilling drops
of apraclonidine 0.5% (IOPIDINE) and phenylephrine in secuentials dilutions,
objectifying the same result with both tests: a reversal of anisocoria.
Results: A Cranial and cervical CT was performed showing an anfractuous
image in parapharyngeal space. Biopsy was taken and the result showed a
high grade B diffuse lymphoma.
Conclusion: In HS miotic pupil presents hypersensibility due to adrenergic
denervation, and is able to dilate with a-1 adrenergic agonists. The HS can
be the first manifestation of a severe disease that could need early diagnosis.
The study of the cavum, although an area inaccessible to direct examination,
is important in the differential diagnosis of HS.
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