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After reading this forum off and on over the last year, I was hoping more residents would become involved. A lot of topics are on continuous repeat. I thought it might be interesting to have discussion or at least mention of interesting patients or surgeries and to possibly discuss recent developments in the literature or news that affects ophthalmology.
A recent interesting case.
1. Teenage patient with M3 AML. Inpatient receiving chemo. Has developed chronic headache and then horizontal double vision. Medication list significant for ALTRA. MRI head read as nl by radiologist. After examining, patient had signs of a left 6th, had papilledema, and the MRI in fact had subtle signs of increased ICP including posterior scleral flattening vertical tortuosity of the nerve. OP after LP was >50. LP had a noted therapeutic effect as well. We diagnosed this patient with PTC secondary to the ALTRA. This responded to diamox and the symptoms and 6th have improved since ALTRA was discontinued.
A recent interesting surgery:
Patient with near total 3rd. As you all know, outcomes are often not very good. We usually try recess/resect procedures or swinging the superior oblique around. We have tried a newer technique where we brought up a periosteal flap from the medial orbital wall and fixed this to the medial rectus insertion. The last patient we disinserted the muscle before attaching the flap and this patient has single vision in primary gaze. I know this technique is being done elsewhere, but I am curious what other resident's experience is with this technique or with surgical treatment of 3rd nerve palsy.
A recent interesting case.
1. Teenage patient with M3 AML. Inpatient receiving chemo. Has developed chronic headache and then horizontal double vision. Medication list significant for ALTRA. MRI head read as nl by radiologist. After examining, patient had signs of a left 6th, had papilledema, and the MRI in fact had subtle signs of increased ICP including posterior scleral flattening vertical tortuosity of the nerve. OP after LP was >50. LP had a noted therapeutic effect as well. We diagnosed this patient with PTC secondary to the ALTRA. This responded to diamox and the symptoms and 6th have improved since ALTRA was discontinued.
A recent interesting surgery:
Patient with near total 3rd. As you all know, outcomes are often not very good. We usually try recess/resect procedures or swinging the superior oblique around. We have tried a newer technique where we brought up a periosteal flap from the medial orbital wall and fixed this to the medial rectus insertion. The last patient we disinserted the muscle before attaching the flap and this patient has single vision in primary gaze. I know this technique is being done elsewhere, but I am curious what other resident's experience is with this technique or with surgical treatment of 3rd nerve palsy.