Clinical Eye and Vision Care

Optic nerve head drusen or hyaline bodies represent calcific material that is confined to the anterior lamina cribrosa but within the optic nerve head. These calcium deposits are believed to be derived from the axonal debris resulting from alterations in axoplasmic flow. Optic nerve heads with drusen are small in size, have an elevated appearance and irregular margins. The presence of optic nerve head drusen can cause visual field defects and may alter the vascular supply to the nerve. Progressive damage is possible and can result in ischemic optic neuropathy. The following is a case report of a patient with optic nerve head drusen, greater in the left eye than in the right, who presented with hemorrhage and disc edema in the left eye caused by the drusen.

Helene M. Hordines O.D

Optic nerve head drusen causing disc hemorrhage and disc edema

视神经乳头玻璃疣引起视盘出血和视盘水肿

Congenital optic disc anomalies including optic disc drusen, optic pits, tilted discs, and optic nerve colobomas, can produce visual field defects that may be difficult to differentiate from glaucoma. This presents a diagnostic challenge in the patient with both a congenital optic nerve anomaly and elevated intraocular pressure (IOP). Patients with anomalous discs and visual field loss along with elevated IOP should be considered for anti-glaucoma therapy because of the difficulty detecting glaucoma damage. The case reports presented will discuss management of patients with optic disc anomalies and progressive visual field loss.

S O D Nadia Zalatimo

Management of glaucoma suspect patients with congenital optic disc anomalies

先天性视盘异常的疑似青光眼患者管理

Leo Semes

Book review

书评

Giant cell (temporal) arteritis is a granulomatous arteritis affecting medium to large sized arteries. This disease strikes the elderly population and is associated with severe visual and systemic morbidity and mortality from ischemic complications secondary to arteritic thrombosis. Early detection and treatment with high dose corticosteroids is the only safeguard against the devastating effects of this disease. A high level of suspicion in an at risk population, and the clinician’s awareness of both the common and obscure premonitory signs and symptoms is crucial for early diagnosis and treatment of this disease. Patients have a much better prognosis if appropriate treatment begins before the irreversible manifestations of the disease occur.

Shari E. Strier O.D.

Giant cell (temporal) arteritis: a new perspective and high index of suspicion allow for earlier diagnosis and treatment

巨细胞（颞）动脉炎：新视角和高度的怀疑指数有助于早期诊断和治疗

Congenital optic nerve pits are a rare ocular anomaly that have been described in past literature as focal colobomas of the optic nerve. Typically, congenital pits do not cause visual loss unless associated with a serous macular detachment. Serous detachment secondary to optic pits has been reported in 25–75% of cases. The pathogenesis of optic nerve pits and associated serous macular detachments remains controversial. This paper will discuss the diagnosis, pathogenesis, management, and treatment of congenital optic nerve pits and associated serous macular detachments.

David D. Reed O.D.

Congenital pits of the optic nerve

先天性视神经凹

This report describes a patient who initially presented with established chloroquine retinopathy resulting in reduced distance visual acuity, color vision anomalies and maculopathy in each eye. Subsequent trauma to the left side of the head produced a further decline in vision, accompanied by iritis and macula edema. A differential diagnosis, classification and treatment plan for patients with chloroquine retinopathy is presented.

JK Portello

Chloroquine retinopathy and secondary trauma

氯喹视网膜病变与继发性创伤

A limited number of conditions are associated with corneal crystals. This clinical challenge discusses a patient who presented with fine, refractile, crystalline deposits throughout the entire depth of corneal stroma in a limbal to limbal pattern. The differential diagnoses of corneal crystals are presented and discussed, along with the causative condition in this case.

Thu-Ha Dao Easter

Chung Yong Song

Corneal crystals

角膜结晶

Objectives: This purpose of this study was to characterize retinitis pigmentosa (RP) patients at the Southeastern Blind Rehabilitation Center (SBRC) by inheritance pattern, and compare the results with similar studies. Study Design: Records of all RP patients who were in the blind rehabilitation program at the SBRC between 1989 and 1993 were reviewed (n=50). Patients were included in the study who could be personally contacted and whose records were complete (n=43). Pedigrees were obtained through review of records and patient interviews. Results: The analysis showed 24 patients (55.8%) were simplex (no family history of RP), 8 patients (18.6%) were autosomal dominant, 4 patients (9.3%) were probable autosomal dominant, 4 patients (9.3%) were autosomal recessive, 2 patients (4.7%) were probable autosomal recessive and 1 patient (2.3%) was X-linked recessive. Conclusions: Unique trends were apparent in the distribution of inheritance patterns. Clinicians should be aware of the large number of simplex patients found in this and the majority of similar studies.

Janis Ecklund Winters

Retinitis pigmentosa: distribution of inheritance patterns in a VA blind rehabilitation center population

视网膜色素变性：VA盲人康复中心人群中的遗传模式分布

A vortex varix consists of a bulging of the vortex ampulla and overlying retina. This dynamic retinal finding can change with the patient's direction of gaze. The clinician can often visualize a red, elevated lesion that appears and disappears thus, making the diagnosis confusing. An overview of vortex varices, methods of diagnosis and differential diagnoses will be discussed.

Dawn N. Tomasini

Varix of the vortex ampulla: a dynamic phenomenon

涡旋壶腹静脉曲张：一种动态现象

Progressive outer retinal necrosis (PORN) syndrome is a form of the Varicella zoster virus (VZV) chorioretinitis found almost exclusively in people with the acquired immunodeficiency syndrome (AIDS). This destructive infection has an extremely rapid course that may lead to no light perception in affected eyes within days or weeks. Attempts at its treatment have had limited success. Rhegmatogenous retinal detachments often occur after the development of atrophic retinal holes, and silicone oil temponade has been found to be the most successful reattachment procedure. Unfortunately, cataract formation is common after such surgery. PORN needs to be differentiated from acute retinal necrosis (ARN) syndrome, a necrotizing retinitis that can also be caused by VZV. PORN and ARN are found at opposite ends of the spectrum of necrotizing herpetic retinopathies (NHR), where its clinical presentation depends upon immune system status. After a brief case presentation, the distinguishing clinical characteristics of PORN, its differentiation from ARN, attempts at its treatment, the role of the immune system status on its clinical appearance and treatment, and management of complications such as retinal detachment and subsequent cataracts are discussed.

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Clinical Eye and Vision Care

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