Correspondence
Cerebellopontine angle astrocytoma producing Bruns nystagmus mimicking vestibular schwannoma
Cerebellopontine angle (CPA) extra-axial lesions (e.g., classically the vestibular schwannoma) may cause a characteristic neuro-ophthalmologic sign known as the Bruns nystagmus, a gaze-evoked horizontal nystagmus when looking away from the lesion and a gaze-paretic type nystagmus when looking toward the lesion. In contrast, intra-axial exophytic CPA astrocytomas are rare and, to our knowledge, have not been reported in the English-language ophthalmic literature previously as a cause of Bruns nystagmus.A rare association: Cushing disease and central serous chorioretinopathy
Central serous chorioretinopathy (CSCR) consists of subretinal accumulation of serous fluid leading to a circumscribed detachment of the neural retina.1,2 The fluid accumulates in the macular region, resulting in decreased visual acuity, blurry vision, color desaturation, metamorphopsia, and impaired dark adaptation.1 Although the pathogenesis of CSCR remains unknown and most cases are idiopathic, excess corticosteroid levels have been reported in association with CSCR.3 This is rare in the setting of Cushing disease.Perioperative nonarteritic anterior ischemic optic neuropathy in Jehovah’s Witnesses
A 62-year-old, female, African American, Jehovah’s Witness experienced bilateral and simultaneous vision loss 2 days after hip arthroplasty. Her 5-hour supine hip replacement surgery resulted in 1 L of blood loss; given her religious status, she refused replacement blood products. Her hemoglobin was 6.3 g/dL preoperatively and 4.7 g/dL postoperatively. The etiology of her preoperative anemia was not known. Her lowest postsurgical blood pressure was 75/45 mm Hg. Her hypotensive medications were discontinued, she was kept in Trendelenburg position, and was treated with intravenous (IV) iron and darbepoetin alfa.Retrobulbar hemorrhage and prasugrel
Retrobulbar hemorrhage (RBH) is the accumulation of blood in the orbit behind the globe. Although some hemorrhages are minor and do not result in significant mass effect, an RBH is an ophthalmologic emergency requiring immediate surgical intervention. An RBH manifests as acute ipsilateral orbital pain and proptosis and can be variably associated with loss of vision, ophthalmoplegia, subconjunctival hemorrhage, and increased intraocular and intraorbital pressure.1 Most cases of RBH are traumatic or postsurgical, but some occur spontaneously in patients with bleeding diatheses.Acute myelogenous leukemia presenting with uveitis, optic disc edema, and granuloma annulare: Case report
Although ocular manifestations of the acute leukemias have been reported commonly, the majority of these reports refer to acute lymphoblastic leukemia rather than Acute myelogenous leukemia (AML).1 Uveitis is a rare finding with AML. In cases in which uveitis has been reported as a manifestation of AML, it has been identified most commonly as a sign of relapsing or progressing AML rather than as the initial presenting finding of previously undiagnosed AML.2–6 We report a patient with AML who presented with uveitis, optic disc edema, and an additional suggestive skin finding of granuloma annulare (GA).
