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Neuro-Ophthalmology at AOS 2022: Three of the Best

Case studies are always an interesting format for the Media MICE team to cover and some of our favorite articles have originated from the more unusual situations patients find themselves in. It’s always fascinating to read a report about something that’s happened out there in the real-world, something that’s not just a study, as hearing about unusual medical situations is always exciting when coming straight from the doctor’s mouth. When it comes to case studies from neuro-ophthalmology, in particular, we really start salivating as there are some really cool cases to consider out there.

Attending the 5th ASEAN Ophthalmology Society Virtual Congress (AOS 2022) gave the whole Media MICE team a marvelous opportunity to really sink our teeth into some of the best neuro-ophthalmology case studies out there. The conference brought together some of the leading ophthalmology minds in the region and from further abroad. So let’s take a look at some of the coolest cases out there.

Give us the GIFs

Let’s start with a first for Media MICE, that being the use of an animated image (called a GIF) in a case study presentation during a conference that showed the deviation of a patient’s right eye. Kudos! The presentation in question, Recurrent Isolated Pupil Involving 3rd Cranial Nerve Palsy, was given by Dr. Aye Kyaw Maung from Myanmar who reported on a compatriot of hers. The male patient was 28-years-old with binocular vertical diplopia and right-sided partial ptosis with headaches and vomiting.

Upon further investigation, Dr. Maung reached a diagnosis of ophthalmoplegia based not only on the significantly reduced movement he experienced (highlighted by the aforementioned GIF), but also on the patient’s extraocular symptoms. She emphasized that ophthalmologists need to be observant for symptoms like headaches and vomiting as they can indicate the development of a complete or incomplete third nerve palsy. Dr. Maung said that complete resolution usually occurs and that a work-up of the pupil must be performed to exclude other causes like an aneurysm.

Back to the Vax

By now we’ve all become familiar with the myriad of COVID-19 vaccines that exist around the world, we know they’re beneficial, but of course, there are always some rare cases involving side effects. COVID-19 Vaccine Associated Optic Neuritis, a presentation by Dr. Franz Marie Cruz (St. Luke’s Medical Center, Manila, the Philippines), examined one such case. A woman in her 40s presented with symptoms (including subacute painless blurring of vision) eight days after one dose of the mainland Chinese-made Sinovax vaccine.

After a thorough examination, the patient was diagnosed with retrobulbar optic neuritis and Dr. Cruz prescribed a treatment regimen of intravenous methylprednisolone at one gram per day for three days, with an oral taper of the same for 11 days. This case inspired our doctor to research ocular complications after COVID-19 vaccination and her first finding was that while rare, optic neuritis can definitely be linked to vaccines. She recommended eliciting previous vaccinations in discussion about a patient’s history, a full work-up, and aiming for good visual outcomes with steroids. She concluded that vaccination against COVID-19 is still worth the risk.

If There’s a Pill, There’s a Kill

We do enjoy a good catchphrase at Media MICE, and one of the best we’ve come across recently is the following: “If there’s an ill, there’s a pill, but if there’s a pill, there’s a kill.” That was coined (or at least presented) by Dr. Erwin D. Palisoc of Manila Central University in the Philippines). His presentation Toxic, and Nutritional Optic Neuropathies examined how some drugs can give rise to these neuropathies.

Dr. Palisoc reported that due to the prevalence of tuberculosis (TB) in the Philippines, ethambutol is often used as a treatment — but it can also lead to optic neuropathy, usually reversible with potentially some minor visual damage. Isoniazid is also used in TB treatment but this can sometimes result in vision loss, central or cecocentral scotomas, and possibly dyschromatopsia. Cardiac medicines, specifical amiodarone, can also cause optic neuropathy (with visual field defects and bilateral optic disc swelling) and can also result in corneal vortex keratopathy.

Editor’s Note: The 5th AOS Congress was held virtually on March 26-27, 2022. Reporting for this story took place during the event.

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