Purpose We present a case report of bilateral visual loss and paraplegy in patient with metastatic carcinoma of stomach. Methods 64‐year old male presented with painless visual loss on right eye, and one week later, he was blind on both eyes with no light perception and amaurotic pupils. One year earlier he was diagnosed with primary metastatic carcinoma of stomach and was treated by Xeloda and Docetaxel. Fundi revealed bilateral hyperemic disc oedema. Solu‐Medrol 1 g i.v. for three days had no effect. Results CT and MRI of brain showed no lesion that would explain his visual loss. Scotopic and photopic electroretinography was normal.Visual evoked potentials (VEP) on flash stimulation were nonrecordable. Specific onco‐neurologic antibodies in CSF and serum were negative:anti‐Ri(ANNA‐2),anti‐Yo,anti‐CV2(CRMP5),anti‐amphiphysin,anti‐Mal,anti‐Hu(ANNA‐1),anti‐Ma2(Ta‐). One month after onset of blindness, he had acute neurological deterioration with paresis of left leg and retention of urine which was diagnosed as Brown‐Sequard syndrome. MRI of spinal chord showed intramedular lesion between Th 6‐10. Oligoclonal bands in serum and CSF were identical, indicating systemic inflammation. Serum was sent for testing NMO‐IgG,but results are in process. Patient was restarted on high doses of Solu‐Medrol i.v. Slight improvement of vision was noted after few days of therapy, and flash‐evoked VEP was barely detectable. The discs were no longer swollen and appeared pale. Conclusion This unusual case of bilateral blindness due to optic neuropathy might be linked to atypical presentation of neuromyelitis optica or to paraneoplastic optic neuropathy caused by yet unknown antigen.

Purpose Silicone stent intubation is used in DCR procedures to prevent a restenosis of the surgical ostium. However, use is not generally accepted due to concers on cost/effectiveness. The goal of our study was to analyze the types and rate of complications associated with monocanalicular and bicanalicular silicones stent intubation nad success rate of DCR procedure. Methods A consecutive series of 114 patients who underwent 120 DCR procedures at our institution from November 2005 on has been included in the study. All DCR (transcanalicular laser DCR’s) procedures were performed under general anaesthesia. One of two types of silicone intubation was inserted at each procedure: bicanalicular silicone stent (72 cases), and inferior monocanalicular stent alone (38 cases). In the former a metallic clip was used to secure the stents in the nasal cavity, in the latter a double knot was applied. The intubation has been removed after 4 months. Results We encountered the following complications: cheese‐wiring of lacrimal punctum (14 cases), prolaps of intubation at the punctual side (9 cases), irritation of conjunctiva (3 cases), corneal erosion (1 case), retention of metallic clip in lacrimal sac (1 case). We statistically analyzed and compared the rate of complications for both types of intubation. Decubitus of the lacrimal punctum was less frequent with monocanalicular intubation compared to bicanalicular intubation; other complications were present at similar rates. Conclusion Complications with silicone stent intubation are not difficult to cope with and normally do not produce adverse effect on DCR success rate with the exception of early and complete prolaps of intubation, which is associated with a lesser success rate of DCR.

Purpose To report clinical and genetic characterization of two related patients with Leber hereditary optic neuropathy (LHON). Methods A 20‐year old man was referred in September 2004 for acute, painless and severe visual loss in his left eye, and then three weeks later in the other. Visual acuity (VA) on presentation was 0.2 in his right eye and HM in his left eye. His 11‐year old cousin was referred in December 2006 for acute and painless visual loss on both eyes with VA of CF in his right eye and 0,3 on his left eye. Fundus examination in both patients revealed engorged optic disc with telangectatic and tortuous vessels with no leakage on fluorescein angiography. MRI of brain was normal in both patients. There were loss of N95 vawe in PERG and abnormal VEP suggesting retinal ganglion cell loss and optic nerve disease. In first patient, VA decreased to HM on both eyes in few months and in 4,5 year follow up didn’t improve.In second patient, VA decreased to 0.001 on right eye and 0.04 on left eye in 2,5 year follow up. Results Genetic tests of the mitochondrial(MT) DNA for three most common mutations (m.11778 G> A, m.3460 G>A, m.14484 T>C) responsible for LHON were negative in both patients. Use of Mito‐Chip 2 didn't reveal any mutations,whilst sequencing the entire MT‐genome in the first patient revealed mutation m.13042G>A (homoplasmy) in gene MT‐ND5; for second patient sequencing for this mutation is in process. Conclusion This mutation has not been previously described in association with LHON and was not mentioned in mtDB or mtSNP (single nucleotide polymorphism) database (DB). The mutation is likely to be causative of the disease since no other mutations were found in MT‐genome in a patient with typical clinical presentation of LHON.