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Aline Astorga-Carballo, Juan Carlos Serna-Ojeda, Mayra F. Camargo; Chiasmal syndrome: clinical features in mexican patients, a 5 year review. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5559.
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To evaluate the ocular manifestations of intracranial pathology producing a chiasmal syndrome, for those initially diagnosed or referred to an ophthalmologic institution.
An observational and retrospective study was performed with review of the records of all the patients with a diagnosis of chiasmal syndrome at an ophthalmologic reference center in a 5-year period. The variables analyzed included: demographic data, reason for consultation, visual acuity, visual field defect in Goldmann’s perimetry, afferent pupillary defect, changes in the color vision test, characteristics of the optic nerve and cranial imaging.
104 patients were included with a median age of 52 years (range 4 - 86 years). 54 patients (51.9%) were initially diagnosed because of the ophthalmologic examination, and 50 (48.07%) were referred with the presumptive diagnosis of an intracranial tumor. The median visual acuity at the time of diagnosis was 20/60 in the eye with worst vision, with 41 patients with a vision in one eye severely affected (worst than 20/400). The main symptoms were decreased central vision in 57 patients (54.8%) and changes in the peripheral visual field in 20 (19.2%); other aggregated manifestations like headache and systemic signs for elevated pituitary hormones were present in 10 (9.61%) and 18 cases (17.3%) respectively. Nine patients had a misdiagnosis of glaucoma for years. The most common visual field defect was bitemporal hemianopsia in 59 (56.73%). 54 patients (51.92%) had relative afferent pupillary defect, and in 65 (62.5%) the color vision test was affected. The optic nerve presented changes in 64.4% of the population. Cranial imaging confirmed the presence of an intracranial tumor in 23 cases (22.11%), being the most common pathology a pituitary adenoma.
Ophthalmologic examination could imply the initial diagnosis of intracranial pathology as the ocular manifestations are varied. Decreased vision is a common reason for consultation in patients with chiasmal syndrome, and other neurologic and systemic findings can be present. Complimentary study findings of intracranial pathology include bitemporal hemianopsia in Goldmann’s perimetry, altered color vision test and diagnostic cranial imaging.
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