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Leukocoria Caused by Intraocular Heterotopic Brain Tissue Correction initially referred for monocular hy- paired with a scleral buckling pro- tient. To prevent further self- phema. cedure. The left eye underwent injury, patients should wear anterior segment washout, pars protective polycarbonate goggles, Report of a Case. A 25-year-old plana lensectomy, pars plana vitrec- and they should be monitored white man was initially seen with a tomy, endolaser, and silicone oil in- closely in conjunction with the psy- 1-week history of floaters and de- jection. Intraoperatively, the giant chiatry service. Treatment of the un- creased vision in his left eye. The retinal tears were found to extend derlying disorder with behavior patient had been diagnosed with from the 12:30 to the 4:30 clock po- modification and pharmaco- Tourette syndrome at age 7 years, sition with 4 long radial extensions therapy is essential, and pharmaco- obsessive-compulsive disorder at age to the temporal macula and from the logical agents that antagonize dopa- 11 years, and depression at age 24 6-o’clock to the 11-o’clock position mine are most effective in reducing years. His motor tics involved ex- with 1 long radial extension to the the severity of motor and vocal tics. cessive blinking, blepharospasm, optic disc. There was an additional clapping, jabbing his fingers into his radially oriented posterior retinal Sue Lim, MD eyes, and punching himself in the break. Postoperatively, the retinas Kourous A. Rezai, MD periorbital area. The patient was tak- were attached in both eyes. One Gary W. Abrams, MD ing buspirone hydrochloride (10 mg month later, the left eye developed Dean Eliott, MD twice a day) and clomipramine hy- proliferative vitreoretinopathy with Detroit, Mich drochloride (25 mg twice a day). On retinal detachment and underwent examination, the patient was alert reoperation. At 6 months, the reti- and oriented, and he had no evi- nas remained attached and the vi- The authors have no relevant finan- dence of cognitive impairment. Vi- sual acuity was 20/100 OU. cial interest in this article. sual acuity was 20/200 OD and hand Corresponding author: Dean motion OS. There was no afferent Comment. Ophthalmic manifesta- Eliott, MD, Kresge Eye Institute, pupillary defect. Intraocular pres- tions of Tourette syndrome in- Wayne State University School of sures were 18 OD and 16 OS. Slit- clude frequent blinking and blepha- Medicine, 4717 St Antoine, Detroit, MI lamp examination findings of the rospasm, gaze deviations and (e-mail: [email protected]). right eye demonstrated pigment de- abnormal saccades, and accidental posits on the corneal endothelium, and self-inflicted ocular injuries.3-5 1. Jankovic J. Tourette’s syndrome. N Engl J Med. moderate (2+) aqueous pigmented The retinal detachments in our pa- 2001;345:1184-1192. cells, and posterior subcapsular cata- tient were most likely the result of 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edi- ract. The left eye had a less than repeated, self-induced finger jab- tion. Washington, DC: American Psychiatric As- 1-mm hyphema and many (4+) cir- bing to the eyes since the patient had sociation; 1994:100-105. culating red blood cells in the ante- no other risk factors for retinal de- 3. Tatlipinar S, Sener EC, Ilhan B, Semerci B. Oph- thalmic manifestations of Gilles de la Tourette rior chamber, as well as a dense pos- tachment. In patients with retinal de- syndrome. Eur J Ophthalmol. 2001;11:223-226. terior subcapsular cataract. tachment, factors suggesting a trau- 4. Margo CE. Tourette syndrome and iatrogenic eye Funduscopy results revealed a reti- matic etiology typically include injury. Am J Ophthalmol. 2002;134:784-785. 5. Robertson MM, Trimble MR, Lees AJ. Self- nal dialysis from the 1:30 to the 4:30 unilateral vitreoretinal findings, reti- injurious behaviour and the Gilles de la To- clock position with a macula-on- nal dialysis or giant retinal tear, and urette syndrome: a clinical study and review of 6,7 literature. Psychol Med. 1989;19:611-615. retinal detachment in the right eye. age younger than 40 years. How- 6. Goffstein R, Burton TC. Differentiating trau- Vitreous hemorrhage was present ever, in patients with self-induced or matic from nontraumatic retinal detachment. centrally in the left eye, and there repeated trauma, the vitreoretinal Ophthalmology. 1982;89:361-368. 7. Eliott D, Avery RL. Nonpenetrating posterior seg- were nasal and temporal giant reti- pathologic features may be bilat- ment trauma. Ophthalmol Clin North Am. 1995; nal tears. The right eye was re- eral, as demonstrated by our pa- 8:647-666. Correction Error in Signature. In the Clinicopathologic Reports, Case Reports, and Small Case Series titled “Leukocoria Caused by Intraocular Heterotopic Brain Tis- sue,” published in the March 2004 issue of the ARCHIVES (2004;122:390-393), an error occurred in the signature. On page 393, the signature should have appeared as follows: Sarit Patel, MD, Madison, Wis; Joanne Dondey, MD, Helen S. L. Chan, MB, BS, Elise He´on, MD, Susan Blaser, MD, Toronto, Ontario; Daniel Albert, MD, Madison; and Brenda L. Gallie, MD, Toronto. Drs Dondey and Patel contributed equally to this article. The journal regrets the error. (REPRINTED) ARCH OPHTHALMOL / VOL 122, JUNE 2004 WWW.ARCHOPHTHALMOL.COM 931 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021.
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