Eye Surgery Associates first case study evening of the year focused on “tricky” cases. Drs Hussain Patel and Monika Pradhan welcomed a small group of optometrists to share and discuss some of their more unusual case studies, many of which focused on glaucoma, in an informal setting at Southern Cross’ Specialist Centre on Auckland’s North Shore.
Meningioma
To start the evening, Dr Pradhan introduced two cases. The first, a 24-weeks pregnant 40-year-old who presented with progressive reduced vision in her left eye and visual field loss. The optical coherence tomography (OCT) and visual field results showed no abnormalities, indicating the issue was neurological, she explained. The patient was referred for an urgent MRI scan, which revealed a suprasellar meningioma. Dr Pradhan said most meningiomas are benign (90-92%) and slow growing, although 7% are atypical and 2% anaplastic (malignant).
Meningiomas are more common in women than men and are usually sporadic. Risk factors include exposure to ionizing radiation, say from a history of dental x-rays, and the rare genetic disorder neurofibromatosis type 2 (NF-2). Symptoms include focal seizures, motor and sensory loss, visual loss and diplopia and III and VI nerve palsy. Smaller tumours (>2cm) are usually asymptomatic, said Dr Pradhan, adding that treatment for smaller asymptomatic tumours is usually observation while larger tumours need surgical resection and sometimes preoperative transarterial embolisation as well as radiation.
Glaucoma and other cases
