Human toxic peripheral neuropathies (TxPN) due to occupational chemical exposure are relatively rare compared with medically related peripheral neuropathies. They are however difficult to diagnose due to their clinical and electrophysiologic similarity to nontoxic peripheral neuropathy. Understanding the cardinal tenets of neurotoxicology, as it applies to TxPN, helps differentiate between the toxic and nontoxic peripheral neuropathy. These tenets include: strong dose–response relationship, consistency of clinical response, proximity of symptoms to exposure, correlation between severity of neuropathy and degree of exposure, and improvement of PNS signs and symptoms follows cessation of exposure. A thorough clinical and occupational history is essential in identifying the possibility of a TxPN.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is usually characterized by prominent motor deficits. A pure sensory presentation, labeled chronic sensory demyelinating neuropathy (CSDN), has been reported, but it is unclear if this neuropathy is a distinct clinical and immunologic entity or merely the sensory presentation of the more usual sensorimotor CIDP. We describe 5 patients with what initially appeared to be CSDN; 3 subsequently developed substantial weakness coincident with the electrophysiologic appearance of multifocal motor conduction block. These cases indicate that, in some cases, CSDN may be a transitional clinical stage of CIDP in which the more usual sensorimotor deficits develop later. Immune-based therapy, including intravenous immunoglobulin, was found to be effective in both the pure sensory and sensorimotor types.
<b><i>Objective:</i></b> To evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. <b><i>Methods:</i></b> This is a single-center, retrospective study that included 524 eyes of 262 patients who received concomitant bilateral intravitreal anti-VEGF injections in 2016 at St. Michael’s Hospital, Toronto. If any of the patients were receiving simultaneous bilateral injections on a regular basis prior to 2016, data pertaining to previous injections were also reviewed. Everyone received bevacizumab, ranibizumab, or aflibercept in an office setting. <b><i>Results:</i></b> A total of 9,798 intravitreal anti-VEGF injections (4,899 bilateral injection sessions) were performed in 524 eyes of 262 patients. The average number of bilateral injection sessions per patient was 18.7 ± 14.1. Ranibizumab was the most commonly used anti-VEGF drug (83.8%). The incidence of endophthalmitis was 0.01%, and there were 2 episodes of acute intraocular inflammation among the 9,798 injections (0.02%). All 3 cases occurred after treatment with ranibizumab. There were 2 deaths (0.76%) due to nonvascular causes but no vascular related systemic adverse events were reported. <b><i>Conclusions:</i></b> Same-day bilateral intravitreal anti-VEGF injections present a low rate of complications and are well tolerated by patients. This safe practice may reduce the burden on the health-care system and on the patients.
To compare foveal avascular zone (FAZ) geometric indices using optical coherence tomography angiography (OCTA) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). FAZ morphology was assessed as a possible imaging feature of retinal displacement.This ALIGN post hoc analysis included primary fovea-off RRDs that underwent successful PnR or PPV, and performed OCTA, and fundus autofluorescence at (FAF) 3 months postoperatively at St. Michael's Hospital, Toronto, Canada. FAZ area (mm 2 ), axial ratio, circularity, and roundness were measured, and FAF images were assessed for retinal displacement.Seventy-two patients were included, 78% (56/72) were male mean age was 60 ± 9 years, and 60% (43/72) were phakic. Sixty-five percent (47/72) and 35% (25/72) underwent PnR and PPV, respectively. The mean baseline logarithm of the minimum angle of resolution visual acuity was 1.49 ± 0.76. FAZ circularity was lower after PPV (0.629 ± 0.120) versus PnR (0.703 ± 0.122); P = 0.016. Sixty-six patients had gradable FAF images. Retinal displacement was present in 29% (19/66), 84.2% (16/19) of which had displacement in the macula. FAZ circularity was lower in eyes with displacement in the macula (0.613 ± 0.110) versus those without displacement (0.700 ± 0.124); P = 0.015. There was a moderate negative correlation between 12-month aniseikonia and FAZ circularity(r = -0.262; P = 0.041).FAZ circularity was lower after PPV and in eyes with retinal displacement in the macula. Circularity was negatively correlated with 12-month aniseikonia scores. FAZ circularity may be another imaging feature to consider postoperatively after RRD repair.
To assess the incidence of persistent subfoveal fluid (PSFF) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD) repair and to determine its association with functional outcomes.Posthoc analysis of the PIVOT randomised trial. Eyes with gradable en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) scans at 1-2 months postoperatively were included. Primary outcome was the proportion of patients with PSFF following PnR versus PPV at 1-2 months postoperatively. Secondary outcomes included association of PSFF with Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 3, 6 and 12 months and metamorphopsia score (MCHARTs) at 12 months.Of 176 participants enrolled in PIVOT, 158 (89.8%) had gradable SD-OCT scans. Intergrader agreement was 0.870 (Cohen's kappa). The incidence of PSFF was 16% (13/81) following PnR and 10.4% (8/77) following PPV (p=0.298; OR=1.65, 95% CI 0.64 to 4.23). Median ETDRS score at 3 months postoperatively between eyes with and without PSFF was 71 (IQR=58-78) and 78 (IQR=70-84), respectively (difference=7 letters, p=0.037), with no significant difference at subsequent 6-month and 12-month visits. Median metamorphopsia scores in patients with versus without PSFF were: horizontal: 0.1 (IQR=0-0.3) vs 0 (IQR=0-0.2) (difference=0.1, p=0.228) and vertical: 0.25 (IQR=0-0.4) vs 0 (IQR=0-0.2) (difference=0.25, p=0.148), respectively.There was no significant difference in the incidence of PSFF in eyes undergoing PnR versus PPV for RRD. The presence of PSFF at 1-2 months postoperatively was associated with worse ETDRS letter score at 3 months, but there was no difference at 1 year.NCT01639209.
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