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SN Comprehensive Clinical Medicine 2021Coronavirus disease (COVID-19) can be associated with ophthalmic manifestations like conjunctivitis, retinal haemorrhages, retinal vascular occlusions, papillophlebitis,...
Coronavirus disease (COVID-19) can be associated with ophthalmic manifestations like conjunctivitis, retinal haemorrhages, retinal vascular occlusions, papillophlebitis, and Adie's syndrome. We herein report for a case of a unilateral acute anterior uveitis which was quiescent for 13 years and was reactivated post COVID-19 infection in a 43-year-old Asian Indian male. He had a past history of recurrent unilateral granulomatous anterior and intermediate uveitis in the right eye (RE), and all the investigations done 14 years ago were negative and had been on treatment with topical and oral steroids. He developed cataract 6 months later in the RE and underwent surgery. Patient was in remission for the past 13 years. Uveitis investigations for the present episode were all negative. Topical steroid and cycloplegic helped in resolution of the uveitis. This may be the first instance of reactivation of a quiescent unilateral anterior uveitis following COVID-19 infection.
PubMed: 34124585
DOI: 10.1007/s42399-021-00985-2 -
Scientific Reports May 2021We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral... (Observational Study)
Observational Study
We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie's tonic pupil. This retrospective, observational, case-control study involved 117 subjects, consisting of 56 patients with unilateral Adie's tonic pupil and 61 controls with other causes of unilateral dilated pupils. Subjects underwent the dilute pilocarpine test with one of the two concentrations, 0.125% or 0.0625%. Pupillary light reflex was recorded with a dynamic pupillometer at baseline and at 30-40 min after instilling one of the two concentrations of dilute pilocarpine. Diagnostic accuracy of two different concentrations of the dilute pilocarpine test, 0.125% group versus 0.0625% group, were compared by area under the receiver operating characteristic curve (AUC). Diagnostic ability of the dilute pilocarpine test for detecting denervation supersensitivity in unilateral Adie's tonic pupil was significantly better in the 0.0625% group than in the 0.125% group (AUC = 0.954 vs. 0.840, respectively, P = 0.047). In the 0.0625% group, the change in maximal pupil diameter of ≥ 0.5 mm after topical pilocarpine instillation showed 100% sensitivity and 82.8% specificity for detecting Adie's tonic pupil. This study confirmed that pupillary constriction with 0.0625% pilocarpine is better than 0.125% pilocarpine for detecting denervation supersensitivity in Adie's tonic pupil. Digital pupillometry is a reliable method for assessing denervation supersensitivity in Adie's tonic pupil.
Topics: Adie Syndrome; Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Pilocarpine; Reflex, Pupillary; Retrospective Studies
PubMed: 33980910
DOI: 10.1038/s41598-021-89148-w -
Indian Journal of Ophthalmology Mar 2021With increasing experience, it has been suggested that the SARS-CoV-2 virus has a neurotropic effect. Here, we present a case of a tonic pupil who developed after...
With increasing experience, it has been suggested that the SARS-CoV-2 virus has a neurotropic effect. Here, we present a case of a tonic pupil who developed after COVID-19 infection. A 36-year-old woman presented with progressive photophobia and blurred vision. On neurological examination, loss of deep tendon reflexes accompanying a tonic pupil was detected and brain MR imaging was normal. With this case, we aimed to describe a rare pattern of neurological involvement caused by the possible SARS-CoV-2 virus.
Topics: Adie Syndrome; Adult; COVID-19; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; RNA, Viral; SARS-CoV-2
PubMed: 33595525
DOI: 10.4103/ijo.IJO_3589_20 -
Ceska a Slovenska Oftalmologie :... 2020The aim of the work is to approach the examination of the pupil with a focus on anisocoria, its characteristics and approach to the diagnosis of pupillotonia and...
The aim of the work is to approach the examination of the pupil with a focus on anisocoria, its characteristics and approach to the diagnosis of pupillotonia and Adie's syndrome and its clinical evaluation. Pupil function is important not only in neurophthalmological examination but also in general ophthalmological examination. First of all, we need to know how the reflex arc works in order to be able to exclude or confirm whether the parasympathetic or sympathetic is affected. It is also necessary to know the exact characteristics of the pupil, such as size, shape, placement, function and reaction to light and at close range. Only on this basis can we distinguish pathological features. We do not often encounter this diagnosis, but it is necessary to keep it in mind, especially in the field of neurophthalmology but also in general ophthalmology. We also present three cases of pupilotonia and Adie's syndrome, which we diagnosed at the Department of Ophthalmology, Faculty of Medicine, Comenius University, after the patient himself came by emergency admission or was sent directly to ophthalmology clinic. In the discussion, we present various other diagnoses, where the reflex arc may not be affected, but the pathological pupil is caused by intraocular tumors, general systemic diseases and, last but not least, local therapy or alkaloids.
Topics: Adie Syndrome; Anisocoria; Humans; Pupil; Tonic Pupil
PubMed: 33499645
DOI: 10.31348/2020/33 -
Journal of Neurovirology Dec 2020Since COVID-19 was first reported, different neurological complications have been acknowledged, but their description is constantly evolving. We report a case of...
Since COVID-19 was first reported, different neurological complications have been acknowledged, but their description is constantly evolving. We report a case of concurrent tonic pupil and trochlear nerve palsy in this context. A 62-year-old man reported a 5-day history of binocular vertical diplopia and blurred vision in his left eye, noticing that his left pupil was dilated. He had suffered a flu-like syndrome 2 weeks before. Clinical exam showed a right trochlear nerve palsy and a left mydriatic pupil. MRI, X chest ray, and analytical results were normal. Antibodies for SARS-CoV-2 were positive (low IgM and high IgG titers). Antiganglioside antibodies were negative. A 0.125% pilocarpine test confirmed Adie's pupil diagnosis. The patient was treated with a tapered prednisone dose with resolution of his diplopia but no change in Adie's pupil. This is the first case reporting Adie's pupil as a postinfectious manifestation of COVID-19. An immune-mediated mechanism is presumed.
Topics: Anti-Inflammatory Agents; COVID-19; Diplopia; Humans; Male; Middle Aged; Prednisone; SARS-CoV-2; Tonic Pupil; Trochlear Nerve Diseases
PubMed: 32910433
DOI: 10.1007/s13365-020-00909-1 -
PloS One 2020Near-infrared transillumination is used in the diagnosis and the management of different eye diseases. In particular, it enables the visualization of melanin in the...
Near-infrared transillumination is used in the diagnosis and the management of different eye diseases. In particular, it enables the visualization of melanin in the pigment epithelium of the iris. This technique is valuable in such conditions as pigment dispersion syndrome and Adie's tonic pupil. Thus, objective quantification of the amount of melanin shedded from the iris pigment epithelium may help in the management of these conditions. By combining aperture photometry with near-infrared iris transillumination this can be achieved. A total of 4 patients (7 eyes) were examined. Three patients were diagnosed with pigment dispersion syndrome in both eyes. One patient had Adie's tonic pupil in one eye. Near-infrared iris transillumination was performed by using a prototype apparatus. Aperture photometry measurements were carried out through specially developed software. The signal-to-noise ratio of the prototype apparatus was 52 dB (399:1). Each pixel within the near-infrared transillumination image corresponded with an area size of the iris of 85 μm x 83 μm. Measurements were taken from several points of the iris in all patients. The average aperture photometry value of transillumination defects was 1321.53 (ADU) ± 501.08 SD, while the average aperture photometry value of the papillary ruff was 90.83 (ADU) ± 53.4. On average transillumination defects transmit 14.55 times more near-infrared light than the papillary ruff. A prototype apparatus for the capture of near-infrared iris transillumination images and custom software enabling aperture photometry measurements of the obtained images has been developed for the purpose of this study. This study demonstrates a potential application of this technique in the diagnosis and management of patients with such conditions as pigment dispersion syndrome and Adie's tonic pupil.
Topics: Adult; Epithelium; Female; Glaucoma, Open-Angle; Humans; Infrared Rays; Iris; Iris Diseases; Male; Melanins; Photometry; Pigmentation; Transillumination; Young Adult
PubMed: 32143214
DOI: 10.1371/journal.pone.0230210 -
Scientific Reports Jan 2020Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with...
BACKGROUND
Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with diabetic retinopathy (DR) show reduced ipRGC function, as inferred by abnormalities in the post illumination pupil response (PIPR). We explored whether ipRGC function in DR is associated with circadian outputs and sleep/wake behavior.
METHODS
Forty-five participants (15 without diabetes, 15 with type 2 diabetes (T2D) and no DR, 15 with T2D and DR) participated. ipRGC function was inferred from the PIPR (pupil size following stimulus offset). Circadian outputs were melatonin amplitude (overnight urinary 6-sulfatoxymelatonin (aMT6s)) and timing (dim light melatonin onset (DLMO)), and evening salivary cortisol levels. Sleep/wake patterns were measured with wrist actigraphy and insomnia symptoms were assessed subjectively.
RESULTS
Patients with T2D and DR had smaller PIPR and lower urinary aMT6s than other groups (p < 0.001). In adjusted regression models, smaller PIPR was associated with lower urinary aMT6s (β = 4.552, p = 0.005). Patients with DR were more likely to have no detectable DLMO (p = 0.049), higher evening salivary cortisol, greater insomnia symptoms and greater sleep variability compared to other groups. Sleep duration, efficiency and rest-activity rhythms were similar.
CONCLUSION
Reduced ipRGC function in DR is associated with circadian dysregulation and sleep disturbances, although a causal relationship cannot be established in this cross-sectional study. Prospective mechanistic and intervention studies examining circadian and sleep health in these patients are warranted.
Topics: Adie Syndrome; Aged; Cells, Cultured; Circadian Clocks; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Humans; Hydrocortisone; Male; Melatonin; Middle Aged; Reflex, Pupillary; Retinal Ganglion Cells; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders
PubMed: 32005914
DOI: 10.1038/s41598-020-58205-1 -
BMJ Case Reports Jan 2020A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not...
A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie's tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.
Topics: Adie Syndrome; Adult; Diagnosis, Differential; Humans; Male; Photophobia; Pilocarpine; Tonic Pupil
PubMed: 31900299
DOI: 10.1136/bcr-2019-233136 -
Frontiers in Neurology 2019We report a woman with unilateral Adie's pupil associated with peripheral sensorimotor polyneuropathy, elevated anti-Hu antibody, and primary mediastinal small cell...
We report a woman with unilateral Adie's pupil associated with peripheral sensorimotor polyneuropathy, elevated anti-Hu antibody, and primary mediastinal small cell carcinoma (SCC). To our knowledge, this is the first report of Adie's pupil in a patient with mediastinal SCC. Although rare, Adie's pupil and sensorimotor polyneuropathy may be the first manifestation of cancer. Its rapid recognition facilitates an early diagnosis and treatment.
PubMed: 31849812
DOI: 10.3389/fneur.2019.01236 -
Journal of Orthopaedic Surgery (Hong... 2020The primary objective of this review was to determine whether tranexamic acid (TXA) reduces transfusion rates in patients undergoing surgery for hip fractures. The... (Meta-Analysis)
Meta-Analysis
AIMS
The primary objective of this review was to determine whether tranexamic acid (TXA) reduces transfusion rates in patients undergoing surgery for hip fractures. The secondary objective was to assess the effects of TXA on mortality and thromboembolic events in the same cohort.
METHODS
A systematic review of electronic databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials comparing perioperative TXA in patients treated surgically for hip/proximal femoral fractures against placebo. The primary outcome was the proportion of patients requiring blood transfusion. Secondary outcomes were blood loss, mortality, and complications. Meta-analysis was performed using inverse variance and random effects model.
RESULTS
The pooled data from 10 studies involving 842 patients showed that the proportion of patients requiring blood transfusion was significantly less in the TXA group (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.59-0.88). There was no difference between TXA and control groups when comparing mortality (RR 1.17, 95% CI 0.65-2.10), deep venous thrombosis (RR 1.14, 95% CI 0.43-3.06), pulmonary embolism (RR 0.53, CI 0.09-3.02), acute coronary syndrome (RR 1.52, CI 0.18-12.98), cerebrovascular events (RR 0.78, CI 0.16-3.68), or wound complications (RR 1.61, CI 0.51-5.13).
CONCLUSION
There is evidence that TXA reduces the proportion of patients requiring blood transfusions when undergoing hip fracture surgery. However, the small sample size and low event rates for adverse effects preclude any definitive conclusions from being established regarding adverse effects. Future trials should be powered to further assess potential complications and determine the ideal dosage and regime.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Hip Fractures; Humans; Tranexamic Acid
PubMed: 31835969
DOI: 10.1177/2309499019887995