A Combined Approach of Syntonic Phototherapy along with Vision Therapy in Treatment of Rod-Cone Dystrophy: A Ray of Hope - Case Series Report

2021 ◽  
pp. 254-268
Keyword(s):  
Vision Loss ◽  
Peripheral Vision ◽  
Case Reports ◽  
Combined Treatment ◽  
Case Series ◽  
Cone Dystrophy ◽  
Combined Approach ◽  
Case Series Report ◽  
Surgical Treatments ◽  
Vision Therapy

Background: Rod-Cone Dystrophies (RCDs) are characterized by the dominant clinical features of rods manifestation predominantly over the cones such as night blindness and peripheral vision worsening that leads to restricted activities of daily living. There are no medical or surgical treatments available for this disease. A combined approach of syntonic phototherapy along with the vision therapy may be a viable treatment option for the improvement in visual efficiency skills and visual function of RCD patients. Case Reports: Case 1: A female, aged 47 years old, diagnosed with severe RCD and complained of poor sight and difficulty in seeing at night in both eyes along with progressive diminution of vision for the past ten years. Case 2: A boy, 11 years of age, diagnosed with severe RCD and presented with major complaints of progressive vision loss, photophobia and falling short in school performance. Both patients were recommended for a combined treatment approach of syntonic phototherapy combined with vision therapy to be completed in our centre. Conclusion: These two patients showed significant improvement in visual acuity, oculomotor motility and visual field. Further research is recommended to enrich our understanding on the use of syntonic phototherapy along with vision therapy in managing patients with RCD which otherwise lacks in specific medical or surgical treatment.

Pediatric Anisometropia: Case Series and Review

2020 ◽  
pp. 32-56
Keyword(s):  
Vision Loss ◽  
Age Of Onset ◽  
Case Reports ◽  
Clinical Care ◽  
Case Series ◽  
Visual Outcome ◽  
Response To Treatment ◽  
Home Based ◽  
Poor Treatment Outcome ◽  
Vision Therapy

Background: The etiology and natural course and history of pediatric anisometropia are incompletely understood. This article reviews the literature regarding pediatric anisometropia with much of the review integrated into a case series. The review and case reports are intended to elevate clinical understanding of pediatric anisometropia including and especially treatment outcomes. Case Reports: Case one is anisomyopia with amblyopia that resulted in a poor treatment outcome despite outstanding compliance with prescribed spectacles, vision therapy, and occlusion. Case two is anisometropia caused by organic vision loss from optic neuritis early in life. Case three is an infant with hyperopic anisometropia and esotropia. The esotropia did not respond to spectacles and home based vision therapy. Neonatal high bilateral hyperopia that converted to anisometropia because of early onset cosmetically invisible unilateral esotropia is speculated. Case four describes a boy diagnosed with hyperopic anisometropia at age 11 months coincident with a diagnosis of pseudoesotropia. His compliance with prescribed spectacles was spotty until age three years. An outstanding visual outcome was achieved by age five years with spectacles only (no occlusion therapy). Case five concerns a boy who acquired hyperopic anisometropia because one eye experienced increasing hyperopia during his toddler years. His response to treatment, spectacles and part time occlusion with home vision therapy, was outstanding. Case six is an infant diagnosed with 2.50 diopters of hyperopic anisometropia at age six months. Monocular home based vison developmental activities, not glasses, were prescribed. Her anisometropia vanished three months later. Conclusions: Pediatric anisometropia presents and responds to treatment in a variety of ways that challenge clinical care. Etiology and age of onset, which usually elude clinicians, can explain this variety. Additional research is required to improve clinical outcomes.

BYNOCS®1 – A Cloud-Based Indigenous Tele-Health Vision Therapy Software for the Assessment and Management of Binocular Vision Disorders

2020 ◽  
pp. 243-251
Keyword(s):  
Visual Acuity ◽  
Binocular Vision ◽  
Case Reports ◽  
Case Series ◽  
Strabismus Surgery ◽  
Care Practice ◽  
Digital Era ◽  
Vision Assessment ◽  
User Friendly ◽  
Vision Therapy

Background: Binocular vision assessment is an integral part of an eye and vision care practice. With the need for a user friendly, simplified, and comprehensive tool especially in this digital era, we propose a new indigenous cloudbased software, Bynocs.® This manuscript describes the technical details, the functioning of this indigenous software, and a case series demonstrating the application and efficacy of Bynocs® as a tele-health vision therapy tool. All the three cases were handled remotely through the Bynocs tele-health vision therapy platform. Case Reports: Case 1: This is a case of symptomatic convergence insufficiency who had prior compliance issues with a conventional vision therapy approach. With 10 sessions of Bynocs vision therapy focused on improving convergence amplitudes, the patient showed significant improvements in both subjective and objective parameters. Case 2: This case is of a 12 year old child with residual anisometropic amblyopia who had excellent compliance with patching therapy for 3 years but visual acuity had plateaued over the last 6 months. After 20 sessions of Dichoptic amblyopia therapy, best-corrected visual acuity (BCVA) improved by 3 log MAR lines, with improvements in stereoacuity to 100 sec of arc. Case 3: This case of a 10 year old child with residual exophoria after strabismus surgery was referred for managing the residual deviation and associated visual complaints. The child had 20/20 visual acuity in both eyes and 10 prism diopters of residual exophoria at distance and near. After 30 sessions of vision therapy, improvements in fusional vergence amplitudes was achieved along with the deviation restoring to orthophoria at both distance and near, with further improvements in stereoacuity from 400 sec of arc to 120 sec of arc. Conclusions: As tele-health is finding favor across the globe, Bynocs® can be a valuable tele-health vision therapy tool for in the management of binocular vision anomalies and amblyopia with the functionality for remote diagnosis and therapy.

Treatment of ruptured lenticulostriate artery aneurysms

2008 ◽  
Vol 109 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Chirag D. Gandhi ◽  
Ronit Gilad ◽  
Aman B. Patel ◽  
Abilash Haridas ◽  
Joshua B. Bederson
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Single Institution ◽  
Neurological Outcomes ◽  
Ruptured Aneurysms ◽  
Mean Size ◽  
Lenticulostriate Artery ◽  
The Mean ◽  
Associated Risk Factors ◽  
Surgical Treatments

Object Lenticulostriate artery (LSA) aneurysms are rarely reported in the literature, making management decisions challenging. Conservative, endovascular, and surgical treatments have been described primarily through case reports and reports of individual authors' experiences. The purpose of this study is to report neurological outcomes in a single-institution experience of ruptured lenticulostriate aneurysms treated surgically. Methods The authors have conducted a retrospective review of all cases involving patients with ruptured LSA aneurysms who presented to the Mt. Sinai Hospital neurosurgical service between September 2001 and January 2007. Results Over 5.4 years, the authors treated 6 patients with 7 LSA aneurysms—6 ruptured and 1 unruptured. The Hunt and Hess grade on admission ranged from I to IV, with subarachnoid hemorrhage in 5 of the 6 patients. Catheter angiography confirmed the presence of the aneurysms, and all patients underwent a pterional craniotomy and clipping or resection of the aneurysm, performed by a single surgeon. Associated risk factors in our series of patients included hypertension, cocaine abuse, and intracranial occlusive disease suggestive of moyamoya disease. Two types of LSA aneurysms were identified. The mean size of the 6 ruptured aneurysms was 3.2 mm. The LSA was preserved in 3 of 6 patients, but LSA preservation did not correlate with development of a postoperative infarct, clinically or radiologically. In patients with ruptured aneurysms, the mean modified Rankin Scale score at discharge was 1.7. The 3 patients in whom the LSA was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated. Conclusions This case series demonstrates that surgical treatment of ruptured LSA aneurysms can be an appropriate, effective, and safe therapy.

Radiofrequency Thermoablation and Hypofractionated Radiotherapy Combined Treatment for Bone Metastases: A Retrospective Study

2021 ◽  
pp. 1-5
Author(s):  
Antonio Piras ◽  
Luca Boldrini ◽  
Sebastiano Menna ◽  
Antonella Sanfratello ◽  
Andrea D’Aviero ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bone Metastases ◽  
Rating Scale ◽  
Combined Treatment ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Mean Value ◽  
Second Phase ◽  
Combined Approach ◽  
Radiofrequency Thermoablation

<b><i>Introduction:</i></b> Bone metastases (BMs) are the common cause of cancer-related pain, as approximately 45% of cancer patients suffer from bone pain (BP). Radiotherapy (RT) is well established as BP treatment strategy; also, other approaches have been shown to be effective in this setting. Radiofrequency thermoablation (RFA) in a combined strategy with RT appears to be feasible and effective in the treatment of metastatic BP ensuring a better quality of life. Aim of this retrospective study was to describe a case series of patients with painful osteolytic lesions at risk of fracture treated with the RFA-RT combined approach, analyzing local control and pain control as outcomes. <b><i>Methods:</i></b> Data of all patients with BM treated with combined approach in our center from April 2016 to June 2020 were retrospectively analyzed. Patients underwent RFA followed by cementoplasty on the same day and RT in a second phase. RT dose ranged between 30 and 37.5 Gy in 5/10 fractions. BP was evaluated according to the numeric rating scale (NRS), at the beginning of treatment and at 1, 2, 3, 6, 9, and 12 months from the end of combined treatment. <b><i>Results:</i></b> A total of 27 patients were treated from April 2016 to June 2020 with RFA-RT combined approach. The large majority of patients underwent stereotactic body radiotherapy (SBRT) (23/27). All patients experienced an NRS value decrease &#x3e;2 at 1 month and between the first and second months. NRS mean value reached 0 at 3, 6, 9, and 12 months’ evaluations. <b><i>Discussion/Conclusion:</i></b> The results of this retrospective analysis of patients treated with RFA-RT combined approach for BP support its safety and efficacy in terms of pain reduction. SBRT role in this combined approach has to be investigated in randomized trials.

POSSIBILITIES OF PROTON THERAPY IN THE TREATMENT OF PEDIATRIC SKULL BASE CHORDOMAS: A CASE SERIES REPORT

2021 ◽  
Vol 100 (3) ◽  
pp. 272-279
Author(s):  
N.A. Vorobyov ◽  
◽  
N.I. Martynova ◽  
D.A. Antipin ◽  
K.F. Boiko ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Malignant Tumors ◽  
Case Reports ◽  
Case Series ◽  
Photon Radiation ◽  
High Dose ◽  
Primary Bone Tumors ◽  
Case Series Report ◽  
High Doses ◽  
Skull Base Chordomas

Chordomas are rare malignant tumors that account for no more than 4% of primary bone tumors. The incidence of chordomas in children does not exceed 5%. Tumor removal is the primary method of treatment, however, due to the high frequency of non-radical surgery, most patients require an adjuvant course of radiotherapy. Photon radiation therapy in doses of 50–60 Gy does not provide the required antitumor effect. At the same time, the use of a proton beam allows delivering a dose of 72 Gy or more with low toxicity. The article presents 4 clinical case reports of base-skull chordoma in children describing their own experience with proton therapy. An analysis of radiation exposure plans was carried out, with an evaluation of the main qualitative indicators characterizing the high-dose coverage of tumours and the radiation load on healthy tissues. The case reports described confirm that the technique of proton irradiation with a pencil beam makes it possible to safely administer ultra-high doses of radiation in close proximity to healthy tissues, including in children. Further improvement of the irradiation planning technique is required, which will improve the target coverage with a high dose of ionizing radiation.

scholarly journals Cystoid maculopathy is a frequent feature of Cohen syndrome-associated retinopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre-Henry Gabrielle ◽  
Laurence Faivre ◽  
Isabelle Audo ◽  
Xavier Zanlonghi ◽  
Hélène Dollfus ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Longitudinal Optical ◽  
Cone Dystrophy ◽  
Retrospective Case ◽  
Correlative Analysis ◽  
Cohen Syndrome ◽  
Pathogenic Variants ◽  
High Prevalence ◽  
Oct Imaging

AbstractCohen syndrome (CS) is a rare syndromic form of rod-cone dystrophy. Recent case reports have suggested that cystoid maculopathy (CM) could affect CS patients with an early onset and high prevalence. Our study aims at improving our understanding and management of CM in CS patients through a retrospective case series of ten CS patients with identified pathogenic variants in VPS13B. Longitudinal optical coherence tomography (OCT) imaging was performed and treatment with carbonic anhydrase inhibitors (CAI) was provided to reduce the volume of cystoid spaces. CM affected eight out of ten patients in our cohort. The youngest patient showed a strong progression of macular cysts from the age of 4.5 to 5 years despite oral CAI medication. Other teenage and young adult patients showed stable macular cysts with and without treatment. One patient showed a moderate decrease of cystoid spaces in the absence of treatment at 22 years of age. Through a correlative analysis we found that the volume of cystoid spaces was positively correlated to the thickness of peripheral and macular photoreceptor-related layers. This study suggests that CAI treatments may not suffice to improve CM in CS patients, and that CM may resolve spontaneously during adulthood as photoreceptor dystrophy progresses.

Optometric Management of Sports-related Post-concussion Visual Symptoms in Teenagers with Vision Therapy: A Case Series

2016 ◽  
pp. 34-51
Keyword(s):  
Visual Processing ◽  
Clinical Observation ◽  
Case Reports ◽  
Case Series ◽  
Ocular Motility ◽  
Blurred Vision ◽  
Visual Symptoms ◽  
History Of ◽  
Reading Glasses ◽  
Vision Therapy

Background: Sports-related concussions are among the most common causes of mild traumatic brain injury (mTBI) in children and young adults. Post-concussion visual problems include: changes in refractive status, binocularity, accommodation, ocular motility, visual processing, and vestibular-visual interaction. Modifications to the traditional optometric exam, use of prisms, lenses, binasal occlusion, tints, filters, and a sequence of in-office vision therapy (VT) can successfully rehabilitate the visual symptoms and improve the quality of life (QoL) for this very unique patient population. Case Reports: 1) A 14 year old male presented with a history of a concussion from soccer. His symptoms included headaches, decreased concentration, difficulty copying form the board and difficulty transitioning from near to far activities. Clinical testing revealed an accommodative and oculomotor dysfunction (OMD). He was prescribed BU yoked prism glasses and vision therapy. 2) A 16 year old female presented with a history of two sports-related concussions from cheerleading. Her symptoms included headaches, blurry vision at near and difficulty keeping her place when reading. Clinical observation revealed OMD and accommodative insufficiency. She was prescribed reading glasses to relieve visual stress when reading while she completed vision therapy. 3) A 19 year old female presented with a history of multiple sports concussions while playing collegiate soccer, which resulted in headaches that became worse when reading, decreased reading stamina and difficulty keeping her place when reading. Clinical observation revealed accommodative insufficiency, binocular dysfunction and OMD. She was prescribed reading glasses and vision therapy. Conclusion: This case series outlines the exam procedures and therapy techniques used to manage three teenagers with postconcussive visual disorders. Symptoms such as blurred vision, headaches and difficulty reading can profoundly affect activities of daily living (ADLs). Optometric examinations and management through the use of prisms, tints, reading glasses, and in-office vision therapy can successfully resolve these visual complaints. Each patient described completed 10-12 sessions of in-office vision therapy [over a span of four to eight months], with home re-enforcement, and graduated with marked improvement of their visual signs and symptoms.

Spontaneous resolution of inflammatory epiretinal membrane: Case series and review of the literature

2021 ◽  
pp. 112067212110362
Author(s):  
Noemi Guemes-Villahoz ◽  
David Diaz-Valle ◽  
Alex Fonollosa ◽  
Maria Jimenez-Santos ◽  
Carlos Narvaez-Palazon ◽  
...  
Keyword(s):  
Epiretinal Membrane ◽  
Spontaneous Regression ◽  
Vision Loss ◽  
Scientific Literature ◽  
Case Reports ◽  
Posterior Vitreous Detachment ◽  
Case Series ◽  
Spontaneous Resolution ◽  
Common Complication ◽  
Review Of The Literature

Epiretinal membrane (ERM) represents a common complication of uveitis that may contribute independently to vision loss in patients with uveitis. Although spontaneous idiopathic ERM separation has been previously reported, to the best of our knowledge there are only two case reports in the scientific literature that depicts spontaneous regression of an inflammation-associated ERM. Spontaneous ERM separation is a rare but possible event, which occurs most often subsequent to posterior vitreous detachment. We present a case series of three patients with uveitis that exhibit the formation and subsequent spontaneous resolution of an inflammatory ERM.

scholarly journals Reduction of collinear inhibition in observers with central vision loss using anodal transcranial direct current stimulation: A case series

2020 ◽  
Author(s):  
Rajkumar Nallour Raveendran ◽  
Amy Chow ◽  
Katelyn Tsang ◽  
Arijit Chakraborty ◽  
Benjamin Thompson
Keyword(s):  
Visual Cortex ◽  
Visual Processing ◽  
Vision Loss ◽  
Peripheral Vision ◽  
Case Series ◽  
Cortical Inhibition ◽  
Peripheral Retina ◽  
Central Vision ◽  
Direct Stimulation ◽  
Central Vision Loss

AbstractPeople with central vision loss (CVL) due to macular degeneration are forced to rely on their residual peripheral vision and often develop a preferred retinal locus (PRL), a region of intact peripheral retina that is used for fixation. At the PRL, visual processing is impaired due to crowding (cluttering of visual objects). The problem of crowding still persists when images are magnified to account for the lower resolution of peripheral vision. We assessed whether anodal transcranial direct stimulation (a-tDCS), a neuro-modulation technique that alters cortical inhibition, would reduce collinear inhibition (an early component of crowding) when applied to the visual cortex in patients with CVL. Our results showed that applying a-tDCS to the visual cortex for 20mins reduced crowding in three patients with CVL and that the effect was sustained for up to 30mins. Sham stimulation delivered in a separate session had no effect. These initial observations mandate further research into the use of a-tDCS to enhance cortical processing of residual retinal input in patients with CVL.

Management of inappropriate sexual behaviors in dementia: a literature review

2010 ◽  
Vol 22 (5) ◽  
pp. 683-692 ◽  
Author(s):  
Inese Tucker
Keyword(s):  
Sexual Behavior ◽  
Sexual Behaviors ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Agents ◽  
Inappropriate Sexual Behavior ◽  
Wide Range ◽  
Case Series Report ◽  
Sexual Disinhibition ◽  
Psychoactive Medications

ABSTRACTBackground: This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia.Methods: A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed.Results: No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior.Conclusions: Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.

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