Intracranial germinomas are malignant neoplasms of gonadal origin, which have some features in terms of age, sex, and clinical manifestations. They mainly occur in children and adolescents. Patients with intracranial germinomas mainly manifest with hypothalamic pituitary axis dysfunction and/or compression syndromes. Visual disturbance is one of the most significant clinical presentations, which is mainly caused by tumor cell infiltration into the optic pathway. In this article, we present three cases of patient with intracranial germinoma to analyze the ocular manifestations. All the three patients presented with endocrine symptoms in the early stage and with visual disturbances (including decreased visual acuity and visual field defects) later. In general, germinoma is diagnosed by its characteristic radiological appearance, supported by tumor markers and/or stereotactic biopsy. However, decisive diagnoses were established when ocular manifestations were presented. A suspicion for germinoma should be considered, when young patients manifest visual disturbances accompanied by endocrine symptoms.
Adolescent ; Adult ; Brain Neoplasms ; diagnosis ; physiopathology ; Female ; Germinoma ; diagnosis ; physiopathology ; Humans ; Male ; Middle Aged ; Vision Disorders ; physiopathology ; Young Adult

We reported a rare case of a dialysis patient coincident pituitary prolactinoma with calcification. A 55-year-old woman who had undergone hemodialysis for 8 years was admitted to the nephrology unit because of headache, blurred vision, and hypotension. Physical examination was normal; endocrinological examination demonstrated elevated serum levels of prolactin (> 4240 mIU/L), but other hormonal profiles, such as growth hormon, adrenocorticotropic hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, follicle-stimulating hormone and luteinizing hormone, were absolutely or relatively lower. A cranial computed tomography (CT) suggested saddle area a high-density screenage with an anteroposterior diameter of 1.0 cm. A cerebral magnetic resonance scan confirmed the pituitary adenoma accompanied with calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor, 14 mm wide round lesion with a high intensity signal. It enlarges the sella turcica, but the optic chiasma is not displaced. We suggest that in the differential diagnosis of any hemodialysis patient with severe headache, hypotension, and visual disturbances, this syndrome should be considered as prompt pituitary adenoma.
Female ; Headache ; parasitology ; Humans ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; physiopathology ; Prolactinoma ; diagnosis ; physiopathology ; Renal Dialysis ; Vision Disorders ; pathology

OBJECTIVE: To investigate the changes of sweep pattern visual evoked response (SPVER) acuity in different temporal frequency. METHODS: The persons were collected and divided into the low visual acuity group (71 eyes) and the high visual acuity group (92 eyes). The eyes were stimulated with different temporal frequency (8.5 Hz, 10 Hz, 15 Hz and 20 Hz, respectively) and the same series of spatial frequency. The accuracy of SPVER acuity in different temporal frequency was evaluated by compare the SPVER acuity with the subjective vision. RESULTS: In the low visual acuity group, there was a good correlation between the SPVER acuity and the subjective vision applying the spatial frequency of the group. In the high visual acuity group, the SPVER acuity was lower than the subjective vision. SPVER acuity showed a good correlation with the subjective vision at the temporal frequency of 10 Hz in two groups. CONCLUSION The temporal frequency can influence SPVER accuracy, so it is necessary to select the suitable stimulation condition in forensic practice.
Adult ; Evoked Potentials, Visual/physiology* ; Female ; Forensic Medicine/methods* ; Humans ; Male ; Photic Stimulation/methods* ; Time Factors ; Vision Disorders/physiopathology* ; Vision Tests/methods* ; Visual Acuity/physiology* ; Young Adult

OBJECTIVE: To compare the vision objectively assessed by SPVERA with the illiterate E Acuity in normal subjects. METHODS: The effect of artificially induced image defocusing on visual acuities (Vas) measured by SPVEP and illiterate E chart measurement was studied in 14 normal subjects. SPVEP was recorded using vertical gratings of 8 different spatial frequencies ranging from 0.235 9 to 30.203 2 c/deg. The responses were averaged and displayed through the discrete Fourier transform on the monitor display. SPVERA was determined by extrapolating the PVER amplitude -spatial frequency function to baseline. SPVERA was compared with illiterate E visual acuity measured under the same conditions of optical defocus. RESULTS: With moderate defocusing (<+1.0 diopter (D),VA > 0.42), the SPVERA were equal to or poorer than the illiterate E visual acuity. With more defocus (> +2.0 diopter (D), VA < 0.3),the SPVERA became better than the illiterate E chart Visual Acuity. The correlation between the two acuities was r2 = 0.919. CONCLUSION SPVERA and the illiterate E visual acuity correlated to a certain degree. We conclude that the SPVERA is effective in estimating vision objectively.
Adult ; Evoked Potentials, Visual/physiology* ; Female ; Fourier Analysis ; Humans ; Male ; Middle Aged ; Pattern Recognition, Visual/physiology* ; Photic Stimulation ; Vision Disorders/physiopathology* ; Vision Tests/methods* ; Visual Acuity/physiology*

BACKGROUNDMyopathies with rimmed vacuoles are a heterogeneous group of muscle disorders with progressive muscle weakness and varied clinical manifestations but similar features in muscle biopsies. Here, we describe a novel autosomal dominant myopathy with rimmed vacuoles in a large family with 11 patients of three generations affected.

METHODSA clinical study including family history, obstetric, pediatric, and development history was recorded. Clinical examinations including physical examination, electromyography (EMG), serum creatine kinase (CK), bone X-rays, and brain magnetic resonance imaging (MRI) were performed in this family. Open muscle biopsies were performed on the proband and his mother. To find the causative gene, the whole-exome sequencing was carried out.

RESULTSDisease onset was from adolescence to adulthood, but the affected patients of the third generation presented an earlier onset and more severe clinical manifestations than the older generations. Clinical features were characterized as dysarthria, dysphagia, external ophthalmoplegia, limb weakness, hypophrenia, deafness, and impaired vision. However, not every patient manifested all symptoms. Serum CK was mildly elevated and EMG indicated a myopathic pattern. Brain MRI showed cerebellum and brain stem mildly atrophy. Rimmed vacuoles and inclusion bodies were observed in muscle biopsy. The whole-exome sequencing was performed, but the causative gene has not been found.

CONCLUSIONSWe reported a novel autosomal dominant myopathy with rimmed vacuoles characterized by dysarthria, dysphagia, external ophthalmoplegia, limb weakness, hypophrenia, deafness, and impaired vision, but the causative gene has not been found and needs further study.

Adolescent ; Adult ; Child ; Deafness ; diagnosis ; physiopathology ; Dysarthria ; diagnosis ; physiopathology ; Electromyography ; Female ; Humans ; Male ; Muscle Weakness ; diagnosis ; physiopathology ; Muscle, Skeletal ; pathology ; physiopathology ; Muscular Diseases ; diagnosis ; physiopathology ; Muscular Dystrophy, Oculopharyngeal ; diagnosis ; physiopathology ; Pedigree ; Vacuoles ; pathology ; Vision Disorders ; diagnosis ; physiopathology ; Young Adult

PURPOSE: The authors hereby describe a case of Wernicke-Korsakoff syndrome with accompanying ocular findings that is caused by hyperernesis gravidarum. METHODS: We experienced a 27-year-old female at 12 weeks of pregnancy, who visited our clinic because of weight loss, gait disturbance, decreased mentality and dizziness after prolonged vomiting for 2 months. Neurological examination demonstrated ataxia of gait and loss of orientation. Ophthalmologic examination showed decreased visual acuity, upbeat nystagmus, diplopia and retinal hemorrhage. RESULTS: We report a relatively rare case of Wernicke-Korsakoff syndrome with ophthalmic symptoms induced by hyperemesis gravidarum. CONCLUSIONS: If a pregnant women has symptoms of severe vomiting along with other ocular findings such as retinal hemorrhage or restricted extraocular movement, one must suspect the diagnosis of Wernicke-Korsakoff syndrome, and should start appropriate treatment immediately.
Vision Disorders/*etiology ; *Pregnancy Complications ; Pregnancy ; Korsakoff Syndrome/*etiology/*physiopathology ; *Hyperemesis Gravidarum ; Humans ; Female ; Eye Diseases/*etiology ; Adult

PURPOSE: To investigate patterns of functional magnetic resonance imaging (fMRI) activation during sentence reading before and after wearing color-tinted lenses. METHODS: A total of 15 Meares-Irlen syndrome patients with a mean age of 23.4 years (range, 13 to 42 years) with no history of neurological or psychiatric disorders were scanned using a 3T MR scanner (Siemens, Tim-Trio, Germany). Each patient underwent two sessions of fMRI imaging (before and after MISViS color-tinted lens application). The fMRI paradigm included a block design of 20 seconds of rest (cross), 20 seconds of activation (sentence reading), and ten blocks (a total of 200 echo-planar image volumes) repeated for each session. Data preprocessing and analyses were performed using the SPM8 software package. RESULTS: The reading speed of patients improved more than 20% while wearing the selected lenses. When compared to the before-lens session, the after-lens session identified significant regions of activation in the left middle and superior temporal gyri (paired t-test; maximal z score, 5.38; Montreal Neurological Institute coordinate, -60 / -39 / 0; threshold at p < 0.05; corrected for multiple comparisons using family-wise error). No region of activation at the same threshold was found in the before-lens session as compared to the after-lens session. CONCLUSIONS: In the current study, we confirmed activation in the left middle and superior temporal gyri during sentence reading after wearing color-tinted lenses. These results could explain the effectiveness of color-tinted lenses in patients with Meares-Irlen syndrome.
Adolescent ; Adult ; Brain/*pathology/physiopathology ; Color Perception/*physiology ; Dyslexia/*diagnosis/physiopathology ; *Eyeglasses ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Perceptual Disorders/*diagnosis/physiopathology ; Pilot Projects ; Reading ; Syndrome ; Vision Disorders/*diagnosis/physiopathology ; Young Adult

OBJECTIVETo understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing.

METHODSFrom a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery.

RESULTSAt the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery.

CONCLUSIONSThe data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Aged ; Aging ; pathology ; Animals ; Cataract ; complications ; physiopathology ; Cataract Extraction ; utilization ; China ; Female ; Follow-Up Studies ; Humans ; Male ; Urban Population ; Vision Disorders ; etiology ; physiopathology

PURPOSE: To examine the prevalence of visual field deterioration in contralateral eyes of patients with worsening open-angle glaucoma and to evaluate the spatial concordance of visual field deterioration between both eyes. METHODS: One hundred sixteen open-angle glaucoma patients who underwent 8 or more visual field examinations over > or =6 years of follow-up were included. The rates of the fast and slow components of visual field decay for each of 52 visual field test locations were calculated with point-wise exponential regression analysis. The spatial concordance of visual field deterioration in contralateral eyes was evaluated with a concordance ratio (calculated as the number of overlapping locations divided by the total number of deteriorating locations) and by comparing the rate of decay in corresponding modified glaucoma hemifield test clusters. RESULTS: The average visual field mean deviation (+/-standard deviation [SD]) was -8.5 (+/-6.4) dB and the mean (+/-SD) follow-up time was 9.0 (+/-1.6) years. Sixty-three patients had mild damage, 23 had moderate damage, and 30 had severe damage. The mean concordance ratio (+/-SD) was 0.46 (+/-0.32) for the mild group, 0.33 (+/-0.27) for the moderate group, and 0.35 (+/-0.21) for the severe group. Thirty-one patients (27%) had deterioration in concordant locations (p < 0.05). Visual field deterioration was greater in the superior hemifield than the inferior hemifield (p < 0.05) when evaluated with both the concordance ratio and modified glaucoma hemifield test cluster analysis methods. CONCLUSIONS: There is only fair spatial concordance with regard to visual field deterioration between the both eyes of an individual. We conclude that testing algorithms taking advantage of inter-eye spatial concordance would not be particularly advantageous in the early detection of glaucomatous deterioration.
Aged ; Female ; Glaucoma, Open-Angle/diagnosis/*epidemiology/physiopathology ; Humans ; Male ; Middle Aged ; Prevalence ; Space Perception/*physiology ; Vision Disorders/diagnosis/*epidemiology/physiopathology ; Visual Field Tests ; Visual Fields/*physiology

Dengue fever is a viral disease that is transmitted by mosquitoes and affects humans. In rare cases, dengue fever can cause visual impairment, which usually occurs within 1 month after contracting dengue fever and ranges from mild blurring of vision to severe blindness. Visual impairment due to dengue fever can be detected through angiography, retinography, optical coherence tomography (OCT) imaging, electroretinography, event electroencephalography (visually evoked potentials), and visual field analysis. The purpose of this study is to report changes in the eye captured using fluorescein angiography, indocyanine green, and OCT in 3 cases of dengue fever visual impairment associated with consistent visual symptoms and similar retinochoroidopathic changes. The OCT results of the three patients with dengue fever showed thinning of the outer retinal layer and disruption of the inner segment/outer segment (IS/OS) junction. While thinning of the retina outer layer is an irreversible process, disruption of IS/OS junction is reported to be reversible. Follow-up examination of individuals with dengue fever and associated visual impairment should involve the use of OCT to evaluate visual acuity and visual field changes in patients with acute choroidal ischemia.
Adult ; Dengue/*complications/diagnosis/physiopathology ; Electroretinography ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Tomography, Optical Coherence/*methods ; Vision Disorders/*diagnosis/etiology/physiopathology ; *Visual Acuity ; *Visual Fields