Micropulse transscleral cyclophotocoagulation is a promising and relatively new technique that uses repetitive micropulses of diode laser energy, delivered with the Cyclo G6 Glaucoma Laser System (Iridex Corporation), in an off-and-on cyclical manner. This review article provides an update on the latest data available for this technique, including a discussion of the aspects in which there is still limited data, such as the precise mechanism of action, the ideal laser parameters based on total energy levels, as well as an overview of other potentially relevant variables that may be playing an important role in outcomes.

No abstract

No abstract

Background:Sequential nonarteritic anterior ischemic optic neuropathy (NAION) has been reported to occur in approximately 15% of patients within 5 years of the first episode. However, the incidence of presumed previous asymptomatic episode of NAION in fellow eye of patients presenting with acute NAION has not been previously reported. We reviewed charts of patients with acute NAION seen over a 5-year period to determine the frequency of visual field (VF) defect in the fellow eye secondary to presumed previous asymptomatic episode of NAION.Methods:Retrospective chart review of all patients presenting to single, tertiary university-affiliated neuro-ophthalmology practice from January 2016 to September 2021 with diagnosis of acute NAION. Patients were determined to have had a presumed previous episode of asymptomatic NAION in the fellow eye if VF defect and corresponding optic nerve head pallor as well as thinning on peripapillary ocular coherence tomography (OCT) and ganglion cell analysis of macular complex were present and alternate causes of VF were excluded.Results:One hundred ninety-two patients with the diagnosis of acute NAION were identified. One hundred thirty-nine had reliable VFs and were included in this study. VF defects in the fellow eye were present in 63 patients (45.4%). Of these, 54 (39%) were determined to represent previous NAION. In 14 of 139 patients (10%), a presumed episode of previous NAION in the fellow eye was asymptomatic. The most prevalent defect in asymptomatic eye was inferior altitudinal defect sparing fixation (7 of 14, 50%). The presence of obstructive sleep apnea, hypertension, diabetes, age, or sex was not predictive of previous episode of asymptomatic NAION.Conclusion:Unrecognized presumed previous episode of NAION occurred in a significant proportion of patients with acute NAION (14 of 139, 10.1%). In 100% of cases, the VF defect in the asymptomatic fellow eye was in a hemifield where there was a new loss in the symptomatic eye.

Background: Acquired pendular nystagmus is most often seen in patients with demyelinating disease. Although it is often bilateral, rare cases may be monocular. There is paucity of data on the spectrum of clinical presentation, underlying mechanism, and response to treatment in patients with monocular pendular nystagmus. Methods: Retrospective case series of patients with monocular pendular nystagmus seen in 2 tertiary neuro-ophthalmology clinics between January 2019 and June 2022. All patients underwent a complete neuro-ophthalmological assessment and MRI. Results: We describe 5 patients (3 women) aged 31–49 with monocular pendular nystagmus. All had a diagnosis of multiple sclerosis. Three patients had horizontal and 2 had vertical pendular nystagmus. The Snellen visual acuity in the eye with pendular nystagmus varied from 20/20 to 20/200. Two patients were asymptomatic and 3 suffered visually debilitating oscillopsia. Treatment response was available for 2 patients, both of which responded well to treatment with memantine. The pendular nystagmus was observed in the eye with worse visual acuity in 4 of 5 cases (80%). Three patients had bilateral pontine lesions, and 2 had unilateral pontine lesion ipsilateral to the side of nystagmus. Conclusions: Monocular pendular nystagmus in adults is seen most often in patients with multiple sclerosis. Asymmetry in brainstem lesions and afferent visual input may be the culprit. Treatment with memantine may result in significant improvement in symptomatic patients.