Open Access Case study

Unilateral Proptosis Due to Orbital Malignancy and Synchronous Carcinoma Elsewhere

Shashi Ahuja, K. Praveen Kumar, N. G. Rajesh, Praveen Seth, Debadutt Basu

Ophthalmology Research: An International Journal, Page 114-120
DOI: 10.9734/OR/2014/5564

Introduction: Unilateral proptosis is usually a diagnostic challenge to an ophthalmologist. Mass lesions constitute a  common cause of unilateral proptosis in elderly individuals in which lymphoproliferative lesions account for 11%  and metastasis  up to 2- 9% of cases. Literature review showed various tumors metastasizing to the orbit but simultaneous presence of two unrelated tumors in a person are extremely uncommon. The authors wish to report the same to highlight the importance of systemic examination in an elderly patient presenting as unilateral proptosis.

Case Presentation: A 52 year old man presented with complaints of painless, gradually progressing prominence of his right eye (OD) for 8 months. OD showed about 15 degrees of exotropia. Examination revealed an axial proptosis of 6mm by Hertel’s exophthalmometry. It was non-tender and non - pulsatile. CT scan of the orbit revealed OD proptosis with enhancing soft tissue attenuation lesion involving extraconal and intraconal compartments in superolateral aspect of the right orbit abutting proximal portion of the right optic nerve. Lacrimal gland could not be distinguished separately from the lesion

Lacrimal gland biopsy revealed stratified squamous epithelium with subepithelial infiltration by monomorphic population of small lymphoid cells and few immunoblasts suggesting a low grade lymphoproliferative lesion. Immunohistochemical study confirmed a diagnosis of small lymphocytic lymphoma.

Abdominal ultrasound performed for assessment of intraabdominal lymph nodes or visceral enlargement showed diffuse thickening. An endoscopic antral biopsy revealed gastric adenocarcinoma on histopathological examination.

Conclusion: Diagnosis of two synchronous neoplasms of different etiopathogenesis at two sites and exclusion of metastasis is a significant and under-recognized clinical problem. This case highlights the importance of high index of clinical suspicion and thorough systemic examination in the evaluation of a case of unilateral proptosis in an elderly male. 


Open Access Original Research Article

Measurement of Intraocular Pressure in a Porcine Ex Vivo Model Eye

Irene Sanchez, Raul Martin, Fernando Ussa

Ophthalmology Research: An International Journal, Page 55-64
DOI: 10.9734/OR/2014/6364

Aims: To compare the pressure inside and outside the pig eye in relation to the location of cannulation for the injection of liquid into the anterior or vitreous chamber.

Method: Eleven enucleated pig eyes were used. 46 measurements of intraocular pressure IOP were taken with a Perkins tonometer when the eye was cannulated in the anterior chamber. 49 measurements were taken when the eye was cannulated in the vitreous chamber. The eyeball was connected to a low-pressure transducer to control, maintain and modify the pressure in the eyeball.

Results: No significant difference (P=0.138) was found between the Perkins pressure measurements from cannulations in the anterior and vitreous chambers. A linear relationship between transducer and Perkins measurements was found when the eye was cannulated in the anterior chamber (IOP=-7.749+0.763 transducer; R2=0.940, p<0.001) and when it was cannulated in the vitreous chamber (IOP=-7.476+0.730 transducer, R2=0.885, p<0.001). No difference was found between the Perkins/transducer pressure ratios (P=0.500 ANOVA) from cannulations in anterior and vitreous chambers. There were no differences in the measurements among eyes that could affect pressure outcomes. A direct relationship between the insufflate pressure inside the eyeball and the Perkins pressure was found.

Conclusion: The pressure measured by Perkins applanation tonometry in an ex vivo porcine eye model is not correlated with the area of cannulation, keeping constant pressure with a low-pressure transducer. A linear equation was generated that correlates the pressure gauge with IOP Perkins, which would apply to future studies that use the pig eye as an exvivo animal model of hypertension in glaucoma.


Open Access Original Research Article

Comparative Analysis of the Mollon-reffin Minimal Colour Vision Test in Visually ‘Normal’ and Acquired Ocular Disease

Hetan Ajwani, Carmel P. Noonan, Fiona J. Rowe

Ophthalmology Research: An International Journal, Page 65-77
DOI: 10.9734/OR/2014/7274

Aim: Currently a variety of different colour vision tests exist in clinical practice each with its own merits and limitations. The Ishihara test is commonly used to test for congenital deficiency, causing red-green deficits. However acquired deficiency is also common in any ocular pathology affecting the optic nerve. The aim of this study is to compare the Mollon-reffin Minimal Test (MRMT) against the Ishihara and City colour vision tests.

Methods: All three tests were performed within the same clinic visit with a small rest between tests. The main parameters of interest were correlation levels between tests for defect detection, severity grading and defect type classification. We assessed the time taken to complete testing and evaluated the patients experience of test.

Results: We assessed 100 patients and 54 visually ‘normal’ subjects, with re-testing in the latter group to evaluate test-retest reliability. We found a reasonable level of agreement between the MRMT and the other tests once considering possible confounders for defect detection, severity grading and defect type classification in the patient group. There was a strong level of agreement in the visually normal group which suggests a high specificity relative to the other tests. The time taken to perform the MRMT is clinically acceptable in comparison to the City Test.

Conclusions: Patients experiences of the MRMT were positive and they preferred it to the other tests. We recommend that the MRMT be used detect colour vision defects or monitor deficiency, in patients with a significant visual field defect.


Open Access Original Research Article

The Networked Analysis of Static Visual Field Evaluation: A Comparison between Medisoft and Humphrey Software Systems

Hetan Ajwani, Carmel P. Noonan, Fiona J. Rowe

Ophthalmology Research: An International Journal, Page 96-113
DOI: 10.9734/OR/2014/7279

Aim: This study compares and contrasts the integrity of original data once imported to Medisoft from the Humphrey perimeter. We aim to analyse the correlation between reliability indices, mean deviation and pattern standard deviation.

Methods: Visual field results from Humphrey automated perimetry using the 24-2 SITA-FAST strategy were imported to Medisoft. A direct comparison was made from original hard copy printouts from the Humphrey perimeter to hard copy printouts of the Medisoft version of the results. All data was compared using Bland-Altman plots and unpaired t tests.

Results: A total of 50 patients (23 male, 27 female) aged 51 to 91 (mean ± SD: 73.8 ± 11.36) had their visual fields assessed using the 24-2 programme on a Humphrey perimeter (HFA; model 740).

Conclusion: The findings of our study suggest that, overall, there is no clinically significant difference between the Humphrey and Medisoft software systems. However, the Humphrey results were not always reproduced identically using Medisoft software.

Open Access Review Article

Review of the Use of SWAP and FDT for the Early Detection of Visual Field Loss

John McBride, Fiona J Rowe

Ophthalmology Research: An International Journal, Page 78-95
DOI: 10.9734/OR/2014/7268

Background: To review the literature reporting SWAP and FDT for the early detection of visual field loss in glaucoma.

Methods: A review of literature published on Medline, Scopus and Web of Science between 1966 and present was undertaken with only articles in the English language reviewed.

Results: SWAP has high inter and intra subject variability. There is no uniform decision as to what criteria should be applied to define abnormal visual fields. In comparison with standard automated perimetry (SAP) there is controversy as to whether SWAP is reliable in detecting glaucomatous damage. As a screening tool FDT may have potential due to its short testing time and lower test-retest variability. There is a lack of definitive abnormality criteria to define visual field loss with FDT. First and second generation FDT have been found to be comparable to SWAP in terms of diagnostic sensitivity. There is a lack of studies comparing FDT to SAP with longitudinal follow up of visual fields which make it difficult to determine its reliability in identifying pre-perimetric glaucomatous damage.

Conclusion: There is a need for further longitudinal studies on both SWAP and FDT to determine fully their reliability in detecting early visual field loss in glaucoma before SAP.