A 55-year-old man reported a severe headache of 3 days’ duration, left ptosis and left lid swelling before examination. The ocular examination revealed left eye proptosis, severe edema of the left bulbar conjunctiva and lid, increasing intraocular pressure of the left eye and ptosis on the left side with decreased extraocular movement. The right eye was normal. Hematologic studies indicated mild inflammation. An enhanced computed tomography scan revealed proptosis of the left globe and enlargement of the superior ophthalmic vein and cavernous sinus of the left side. Angiography revealed an area of interrupted blood flow in the left cavernous sinus. Enhanced magnetic resonance imaging (MRI) with Gd-DTPA revealed a low-intensity area that was suspected to be a blood clot in the enlarged left cavernous sinus. This case indicates the efficacy of enhanced MRI examination in the early diagnosis of cavernous sinus thrombosis.

No abstract

We tested a personal computer-based video keratometric system used to analyze projected placido disk rings. The system consists of a Maloney surgical keratometer that projects the rings and a video camera attached to an operating microscope. Images of the rings were transmitted to a video image processing board and analyzed on a personal computer using an anlaysis program we developed. System precision was evaluated in 18 eyes. The values were compared with those obtained using a commercial photokeratometer (control). In all eyes, the principal meridian values differed from the controls by < 0.04 mm. In 15 eyes (83%), the measurements were within 0.03 mm of the controls. The corneal astigmatism values and cylindrical axes were within 0.12 diopters in 17 eyes (94%) and within 5" in all cases, respectively. Our system, which can analyze placido disc rings projected from other systems, is sufficiently precise to measure the corneal radius of curvature and astigmatism.

We report a patient with pseudotumor with cystoid macular edema (CME). The initial finding in our case was only CME with a bilateral visual acuity decrease to 20/25. Approximately 3 months later, the visual acuity dropped to light perception in the right eye and 20/200 in the left eye. Computed tomography scan revealed a mass in the right orbital apex and band-shaped enhancement in the cavernous sinus and along the upper margin of the petrous bone. However, no mass was found intraoperatively, and a biopsy specimen of the bulging levator muscle showed polymorphonuclear leukocyte infiltration. The CME resolved postoperatively. The tumor also seemed to resolve; however, after 1 year, the tumor recurred and invaded the brain tissue. A temporal lobectomy revealed widespread inflammatory cell infiltration. To ensure early diagnosis, pseudotumor should be considered in patients with CME of which the cause is uncertain.

We investigated sugar metabolism in lenses isolated from infants with stage-5 retinopathy of prematurity (ROP). The lenses were incubated in ¹³C-labeled glucose (35.5 mM) or galactose (30 mM) for 24 h at 37.5°C. Six to 8 lenses were pooled for each experiment. ¹³C-nuclear magnetic resonance spectroscopy was then performed on perchloric acid extracts of these lenses. Active aldose metabolism was indicated by the production of lactate. However, neither sorbitol nor dulcitol was detected. On the other hand, an experimental aldose reductase inhibitor, sorbinil, caused a decrease in the hexose monophosphate shunt activity suggesting an active polyol pathway. Both polyols therefore appeared to have been metabolized further. In addition, galactose metabolism was unique in that it not only involved a galactose glucose epimerization, but also a direct galactose → ribose conversion, and a production of galactose-3-phosphate. Although it is possible that the ROP lenses have adapted to oxidative stress during the postnatal high-oxygen incubation for premature infants, we believe the observed sugar metabolism is representative of the developing human lens.