scholarly journals How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli

2021 ◽  
Author(s):  
Carina Kelbsch ◽  
Krunoslav Stingl ◽  
Ronja Jung ◽  
Melanie Kempf ◽  
Paul Richter ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Tract ◽  
Occipital Lobe ◽  
Visual Pathway ◽  
Visual Field Defects ◽  
Ischemic Optic Neuropathy ◽  
Low Intensity ◽  
Pupillary Responses ◽  
Patient Groups ◽  
Fundamental Research

Abstract Purpose To examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli. Methods Chromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses. Results A statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015). Conclusion Our results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.

Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

2021 ◽  
pp. 1-11
Author(s):  
Visish M. Srinivasan ◽  
Phiroz E. Tarapore ◽  
Stefan W. Koester ◽  
Joshua S. Catapano ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Visual Fields ◽  
Optic Tract ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Subtotal Resection

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

scholarly journals Visual Field Defect after Cardiac Surgery: The Striking Role of Interdisciplinary Collaboration

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Raffaele Nuzzi ◽  
Carlo Lavia
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Interdisciplinary Collaboration ◽  
Visual Fields ◽  
Cortical Blindness ◽  
Visual Field Defects ◽  
Ischemic Optic Neuropathy ◽  
Intraoperative Hypotension ◽  
Perioperative Visual Loss ◽  
Vascular Occlusions

Perioperative visual loss (POVL) is a potentially devastating complication that can occur following ocular or nonocular surgery. The leading causes of this disease are retinal vascular occlusions, ischemic optic neuropathies, and cortical blindness. POVL pathogenesis is strictly influenced by surgery, anesthesia, and patients’ comorbidities. We report of a 55-year-old caucasian man who presented with complaints of sudden painless loss of vision and unilateral campimetric deficit. We recorded a preserved visual acuity but at fundus examination a bilateral ischemic optic neuropathy (ION) was suspected. Our hypothesis was supported by uncommon and peculiar visual field defects and a history of cardiovascular surgery shortly before was a striking data. When we examined his medical records we found strong accordance with what is reported in literature to be risk factors for postoperative ION development. He presented intraoperative hypotension, anemia, and hypothermia, he was older than 50 years, and surgery lasted for more than five hours. We are currently monitoring his visual acuity and visual fields which remain unchanged. As there is no proved therapy for such severe adverse events, we recommend intraoperative check of blood pressure, blood loss, and body temperature, associated with repeated eye checks and patients’ interview.

MRI of optic tract lesions: Review and correlation with visual field defects

2013 ◽  
Vol 68 (10) ◽  
pp. e538-e551 ◽  
Author(s):  
F. Fadzli ◽  
N. Ramli ◽  
N.M. Ramli
Keyword(s):  
Visual Field ◽  
Optic Tract ◽  
Visual Field Defects ◽  
Field Defects

Transitory and permanent visual field defects induced by occipital lobe seizures

1999 ◽  
Vol 20 (5) ◽  
pp. 321-325 ◽  
Author(s):  
G. Valli ◽  
S. Zago ◽  
A. Cappellari ◽  
A. Bersano
Keyword(s):  
Visual Field ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Field Defects

Clinical Study of the Visual Field Defects Caused by Occipital Lobe Lesions

2014 ◽  
Vol 37 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Katsuhiko Ogawa ◽  
Hiroshi Ishikawa ◽  
Yutaka Suzuki ◽  
Minoru Oishi ◽  
Satoshi Kamei
Keyword(s):  
Clinical Study ◽  
Visual Field ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Field Defects

Recovery of visual-field defects after occipital lobe infarction: a perimetric study

2010 ◽  
Vol 82 (6) ◽  
pp. 695-702 ◽  
Author(s):  
M. Celebisoy ◽  
N. Celebisoy ◽  
E. Bayam ◽  
T. Kose
Keyword(s):  
Visual Field ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Field Defects

scholarly journals Monocular Visual Field Defect on Humphrey 24-2 SITA-Fast Testing Later Identified as a Highly Incongruous Homonymous Defect on Humphrey 30-2 SITA-Fast Testing

2021 ◽  
pp. 507-512
Author(s):  
Caberry W. Yu ◽  
Jonathan A. Micieli
Keyword(s):  
Visual Field ◽  
Visual Field Defect ◽  
Anterior Segment ◽  
Field Testing ◽  
Visual Pathway ◽  
Visual Field Defects ◽  
Inner Plexiform Layer ◽  
Visual Field Testing ◽  
Field Defect ◽  
Field Defects

Monocular visual field defects generally localize at or anterior to the optic chiasm, while homonymous hemianopias localize to the retrochiasmal visual pathway. Highly incongruous visual field defects may be difficult to identify on 24-2 Humphrey visual field testing, and this case demonstrates the value of optical coherence tomography (OCT) ganglion cell-inner plexiform layer (GCIPL) in rapidly localizing the lesion. A 54-year-old woman was found on routine examination to have an isolated superonasal quadrant visual field defect respecting the vertical meridian in the left eye only on Humphrey 24-2 SITA-Fast testing. She had a remote history of significant head trauma. Visual acuity, anterior segment, and fundus examination were normal. OCT revealed a bow-tie atrophy of the retinal nerve fiber layer in the right eye (OD), and binocular homonymous hemi-macular atrophy of OCT GCIPL, confirming the localization was the left retrochiasmal visual pathway. A repeat Humphrey 30-2 SITA-Fast visual field demonstrated that the visual field defect was also present in the OD in a highly incongruous manner. Magnetic resonance imaging of the brain with contrast showed mild atrophy of the left optic tract. This case demonstrates that highly incongruous visual field defects may be difficult to identify on Humphrey 24-2 SITA-Fast visual fields, and OCT GCIPL serves as a rapid way to localize the lesion. More detailed visual field testing including 30-2 programs should be considered in these cases.

Microsurgical Resection of a Chiasmatic Cavernoma: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Alvaro Campero ◽  
Ignacio Casas-Parera ◽  
Juan F Villalonga ◽  
Matías Baldoncini
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Visual Loss ◽  
Brain Mri ◽  
Optic Tract ◽  
Nerve Fibers ◽  
Visual Field Defects ◽  
Cavernous Malformations ◽  
Transsylvian Approach ◽  
The Right

Abstract According to reports from the literature,1,2 depending on the location where cavernomas appear, range from the very common locations to unusual. Cavernous malformations arising from the optic nerve and chiasm are rare, with only few cases reported to date.3-5  We present a case of a 28-yr-old man who suddenly started with sever visual loss in the right eye and homonymous lateral hemianopia in the left eye. Because of the acute symptomatology, a brain MRI was immediately performed in order to diagnose the etiology. The MRI showed a chiasmatic mass with right extension, heterogeneous on T1 and T2 sequences, without enhancement after gadolinium. The surgery was carried out a week after the diagnosis. A right pterional transsylvian approach was performed and the cavernoma was resected with microsurgical maneuvers, preserving the optic nerve fibers, chiasm, and optic tract.  The patient evolved favorably, improving the visual deficit in the postoperative period as can be observed in the postoperative visual field study 7 mo after the surgery.  The patient signed an informed consent for the procedure and agreed with the use of his images and surgical video for research and academic purposes.  Our surgical case emphasizes the importance of a prompt diagnosis and surgery for chiasmatic cavernomas3 associated to visual loss, providing early decompression of the optic apparatus and improvement of the visual field defects after surgery.

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