"Ecstasy" induced immunosuppression and herpes zoster ophthalmicus.
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Adult↗
Biomedical subjects
D H Fischer
Publications and source records attributed to D H Fischer.
Changing trends in paintball sport-related ocular injuries.
OBJECTIVES: To describe the type and severity of ocular injuries caused by paintballs, to summarize the outcomes, to determine if the injury occurred in a commercial or noncommercial setting, to compare the number of injuries in each setting as a function of time, and to ascertain whether eye-protective devices were worn and why they were removed. DESIGN: Retrospective analysis of 35 patients who sustained ocular injuries caused by paintballs and underwent evaluation and treatment at an eye hospital from January 1, 1985, to September 30, 1998. Thirty-five eyes of 35 patients underwent a complete ocular examination, diagnostic testing, and surgical intervention when indicated. RESULTS: All patients were male (average age, 22 years). Twenty-six patients (74%) had an initial visual acuity of 20/200 or worse, and visual acuity in 16 (46%) remained 20/200 or worse on follow-up (range, 2 weeks to 22 months). Traumatic hyphema was seen in 21 patients (60%). Twenty-two patients (63%) had access to goggles, 7 (33%) of whom removed them due to fogging before the injury. Injuries sustained after 1995 were 5.8 times (relative risk, 5.8; 95% confidence interval, 1.5-22.4) more likely to occur during a noncommercial war game than those occurring in 1995 or before. CONCLUSIONS: As the popularity of war games increases, so does the potential for serious ocular injury caused by paint pellet guns. Most injuries seen after 1995 occurred in noncommercial war game settings, where the use of eye-protective devices is not required. Industry standards for eye protection have been developed recently and should be implemented.
Adolescent↗
Treatment strategies for postoperative Propionibacterium acnes endophthalmitis.
PURPOSE: Propionibacterium acnes endophthalmitis after cataract extraction and posterior chamber intraocular lens (IOL) implantation is characterized by a chronic indolent course, frequently associated with recurrence after standard endophthalmitis treatment. This study was designed to evaluate the efficacy of various therapeutic methods in the treatment of primary and recurrent episodes of postoperative P. acnes endophthalmitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-five patients treated at Wills Eye Hospital for P. acnes endophthalmitis. METHODS: The authors retrospectively reviewed the clinical charts and microbiology files of all patients treated at Wills Eye Hospital between January 1991 and April 1998 with culture-proven P. acnes endophthalmitis after cataract extraction and posterior chamber IOL implantation. MAIN OUTCOME MEASURES: Results of cultures and microbiologic examinations, efficacy of various treatment methods in the prevention of recurrent inflammatory episodes, and final visual outcome. RESULTS: Twenty-five patients who met inclusion criteria were identified; initial therapy consisted of 1 of the following: intraocular antibiotic (IOAB) injections alone (2 patients); IOAB combined with pars plana vitrectomy (PPV) (10 patients); IOAB and PPV combined with partial capsulectomy (9 patients); and IOAB, PPV, total capsulectomy, and IOL exchange (4 patients). Nearly half of the patients (10 of 21, or 48%) initially treated with IOAB alone (1 of 2), IOAB and PPV (5 of 10), and IOAB combined with PPV and partial capsulectomy (4 of 9) required further therapeutic interventions for recurrent disease. Retreatment with IOAB alone or combined with PPV and partial capsulectomy in these patients failed to eradicate the infection in three (75%) of four patients. None of the patients (0 of 4) treated initially with total capsulectomy and IOL exchange required additional surgical intervention. Furthermore, none of the patients (0 of 13) who underwent total capsulectomy with IOL removal or exchange or IOL exchange alone as an initial, secondary, or tertiary treatment required further intervention. CONCLUSION: In the authors' series, approximately half of the patients with P. acnes endophthalmitis were treated successfully initially with nonsurgical or limited surgical intervention. All patients treated with total capsulectomy and IOL exchange or removal, either as an initial treatment or for recurrent disease, were cured. Removal of the entire capsular bag and the IOL may be performed as a definitive initial therapy and should be performed for recurrent inflammation.
Adult↗
Taches de bougie.
BACKGROUND: Posterior segment lesions, including taches de bougie, may be the presenting sign of sarcoidosis. In patients with unrecognized sarcoidosis, taches de bougie may be misinterpreted as the lesions of birdshot chorioretinopathy (BCR) or multifocal choroiditis (MFC). METHODS: In a retrospective study, the authors identified 22 patients with taches de bougie and sarcoidosis. A tissue biopsy showed noncaseating granulomas in 17 patients. All available ophthalmic and medical records of these patients were reviewed. RESULTS: Two patterns of taches de bougie were observed. Sixteen patients (73%) had small, discrete white spots in the inferior or nasal periphery, indistinguishable from the lesions of MFC. In six patients (27%), larger, posterior, pale yellow-orange streaks developed that were identical to the lesions of BCR. Visual prognosis was better with posterior streaks. The chest x-ray was normal in 5 of 16 patients with peripheral spots and in 3 of 6 patients with posterior streaks. Serum angiotensin-converting enzyme was negative in 5 of 14 patients. Gallium scan showed increased hilar uptake in five patients, three of whom had a normal chest x-ray. Human lymphocyte antigen A29 was positive in one of nine patients. CONCLUSIONS: Sarcoidosis should be considered in patients with fundus findings that resemble BCR or MFC. Initial evaluation should include chest x-ray and testing the angiotensin-converting enzyme level. These test results may be negative in patients outside the 20- to 40-year age group for typical sarcoid. Further evaluation with nondirected conjunctival biopsy and whole-body gallium scan may be indicated in certain patients, including (1) those with BCR or MFC with normal chest x-ray and elevated angiotensin-converting enzyme level; (2) patients older than 50 years with MFC; or (3) human lymphocyte antigen A29-negative BCR.
Adolescent↗
Hemodynamic alterations in the acute retinal necrosis syndrome.
BACKGROUND: Clinical and histopathologic observations suggest a role for ischemia in the pathogenesis of the acute retinal necrosis (ARN) syndrome. Disruption of blood flow appears to occur at some level in the retina or choroid and may account for some of the major features of the syndrome. METHODS: To investigate these potential circulatory changes, color Doppler imaging (CDI) was used to quantitate blood flow velocities and vascular resistance in the central retinal, ophthalmic, and short posterior ciliary arteries in ten consecutive patients with unilateral ARN syndrome. Data were analyzed with a paired Student's t test. The unaffected fellow eyes served as controls. RESULTS: Blood flow velocities within the central retinal artery were significantly reduced in eyes with ARN syndrome compared with control eyes. In affected eyes, there was a mean reduction of 55%, 60%, and 72% in peak systolic, average, and end-diastolic velocities, respectively (P < 0.01). The calculated vascular resistance of the central retinal artery showed an upward trend, but the data fell short of statistical significance. Blood flow velocities from the ophthalmic and short posterior ciliary arteries were not significantly different compared with controls. CONCLUSIONS: This study demonstrates marked circulatory changes in the central retinal artery of eyes involved with the ARN syndrome. Although the exact mechanism and clinical significance are yet to be determined, the data support the presence of retinal arterial hemodynamic compromise in this condition.
Adult↗
Repair of retinitis-related retinal detachments with silicone oil in patients with acquired immunodeficiency syndrome.
To provide prompt visual rehabilitation and to reduce the need for repeated operations, we performed vitrectomy with silicone oil tamponade in 16 consecutive eyes with retinal detachments related to cytomegalovirus retinitis and acute retinal necrosis in 13 patients with acquired immunodeficiency syndrome. In all 16 eyes (100%), retinas were reattached with one operation. Preservation of ambulatory vision was achieved in six of eight eyes (75%; mean follow-up, 14.6 weeks). No patient with hand motion visual acuity or worse preoperatively recovered ambulatory vision. Visual acuity recovery was limited by optic nerve disease in five eyes (31%). Silicone oil-related side effects did not adversely affect visual outcome in any eye. Six patients (46%) have since died (mean, 4.4 months postoperatively). These data indicated that successful surgical repair of these detachments can be consistently achieved with this approach. The prognosis for ambulatory vision is strongly related to preoperative visual acuity.
Acquired Immunodeficiency Syndrome↗
Propionibacterium acnes endophthalmitis after intracapsular cataract extraction.
The authors report a case of Propionibacterium acnes endophthalmitis after intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The patient's chronic inflammation persisted for 5 years after cataract surgery despite treatment with pars plana vitrectomy, intraocular lens removal, topical and oral steroids, and topical fortified antibiotics. Fluctuations in the inflammation were paralleled by changes in the size and appearance of a white plaque on the posterior corneal surface. Anterior chamber tap cultures were positive for P. acnes after 8 days of incubation under anaerobic conditions. The inflammation was not controlled until the posterior corneal plaque, which was the presumed nidus of the chronic infection, was removed and the patient was treated with intravitreal and oral antibiotics.
Aged↗
Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome.
The authors report a series of 20 eyes from 20 patients in whom inadvertent perforation of the globe occurred during local anesthesia for ocular surgery. Perforation resulted from retrobulbar anesthesia in 18 eyes and from peribulbar anesthesia in 2 eyes. Nine (45%) of 20 eyes had an axial length greater than or equal to 26.00 mm. Combining this figure with axial length data for the general population and estimates for the risk of globe perforation during local anesthesia yields an approximate incidence of perforation in eyes with axial length greater than or equal to 26.00 mm of 1 in 140 injections. Proliferative vitreoretinopathy (PVR) developed in 8 of the 20 eyes (40%) in this series. Overall, 15 (75%) of the 20 eyes were successfully repaired, and, in five eyes (25%), the final visual acuity was 20/70 or better.
Adult↗
Computerised visual field deficits in tears of the retinal pigment epithelium.
Retinal Pigment epithelial tears have been well documented as a complication of pigment epithelial detachment in patients with age related macular degeneration. Spontaneous and iatrogenic separation of detached retinal pigment epithelium, with subsequent retraction and exposure of the underlying choriocapillaris and Bruch's membrane, usually results in poor visual function in the affected areas. However, exact characterisation of the resultant scotomas has not been previously described. We present two patients with spontaneous pigment epithelial tears who underwent Octopus computerised visual field analysis. The density and characteristics of their associated field loss is compared with their clinical and fluorescein angiographic appearance.
Aged↗
Acute retinal necrosis neuropathy. Clinical profile and surgical therapy.
Twelve patients (17 eyes) with the acute retinal necrosis syndrome were analyzed with special reference to the development of an acute optic neuropathy. Six patients (9 eyes) without acute optic nerve involvement were treated with intravenous acyclovir sodium and/or vitreoretinal surgery (group 1). Six patients (8 eyes) fulfilling absolute and relative criteria for acute retinal necrosis optic neuropathy were treated with intravenous acyclovir as well as optic nerve sheath decompression, and, in addition, some of these patients also underwent vitreoretinal surgery. Despite more pronounced initial visual loss compared with group 1, six eyes in group 2 regained visual acuity of 20/400 or better. In contrast, only 2 of 9 eyes in group 1 maintained their entry level visual acuity, and the visual acuities of the remaining 7 eyes deteriorated to counting fingers or worse. Therefore, the acute optic neuropathy complicating the acute retinal necrosis syndrome appears to benefit from prompt recognition and surgical decompression of the intraorbital optic nerve meninges in conjunction with intravenous acyclovir.
Acute Disease↗
Intraocular surgery and the repair of retinal detachments from AIDS-related diseases.
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Acquired Immunodeficiency Syndrome↗
Occult plastic intraocular foreign body.
A 34-year-old man was evaluated for posttraumatic endophthalmitis with hypopyon. A previous CT scan of the orbit along with B-scan ultrasonogram failed to confirm the presence of an intraocular foreign body. Nevertheless, at the time of vitrectomy, a polyvinyl chloride (PVC) plastic foreign body was encountered. The atypical posttraumatic uveitis that developed was apparently secondary to the PVC material, as the inflammation cleared rapidly following removal of the foreign body. This case illustrates the necessity for maintaining a high level of suspicion for the possibility of an intraocular foreign body in the event of ocular trauma, even in the presence of unconfirming ancillary tests.
Adult↗
Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome.
In seven of eight cases of presumed ocular toxoplasmosis in patients with AIDS, the diagnosis was supported by a reduction or resolution of intraocular inflammation and healing of necrotic retinal lesions after initiation of antiparasitic drug therapy including one or more of the following medications: pyrimethamine, sulfadiazine, clindamycin, tetracycline, or spiramycin. In two cases the diagnosis was confirmed histologically. The cases differed clinically and histopathologically from those in immunocompetent patients. There was no evidence that disease originated in preexisting retinochoroidal scars. Lesions frequently were bilateral and multifocal. Vitreous inflammatory reaction was a common clinical finding, but histopathologic examination demonstrated scant retinal inflammation in areas of necrosis. Ocular toxoplasmosis in these patients with AIDS probably resulted from newly acquired infection or dissemination of organisms from nonocular sites of disease. Infections became clinically inactive with drug therapy in all treated patients, but reactivation and progression of disease occurred when therapy was stopped in two of three patients. Severe retinal necrosis led to retinal tears or detachment in three cases. Ocular lesions were the first manifestation of Toxoplasma gondii infection in four of five patients with evidence of multisystem infection.
Acquired Immunodeficiency Syndrome↗
Diagnosis and treatment of chronic postoperative bacterial endophthalmitis.
Chronic postoperative bacterial endophthalmitis has recently assumed a prominent role in differential diagnosis of inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. The optimal diagnostic and therapeutic approach to this entity has not yet been clearly defined. We present a case of chronic postoperative Propionibacterium acnes endophthalmitis in which the diagnosis was made by anterior chamber paracentesis, and topical, periocular, and systemic antibiotic therapy resolved the inflammation. Anterior chamber paracentesis for aerobic and anaerobic cultures may be an appropriate initial diagnostic step in suspected cases. While successful treatment may require surgical intervention in some cases, others may respond to antibiotic therapy alone.
Bacterial Infections↗
The heart and the eye.
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Endocarditis, Bacterial↗
Optic nerve involvement in the acute retinal necrosis syndrome.
Two patients with acute retinal necrosis syndrome demonstrated enlarged computed tomographic images of the optic nerves, a previously undescribed manifestation of this disorder to the best of our knowledge. One patient, with the bilateral variety of this syndrome, demonstrated bilateral optic nerve enlargement and, in one eye, appeared to achieve visual improvement following an optic nerve sheath decompression. The second patient, with the unilateral variety of the syndrome, demonstrated only unilateral optic nerve enlargement. These observations suggest that the intraorbital optic nerve may be primarily or secondarily involved in the acute retinal necrosis syndrome.
Acute Disease↗
The slipped rectus muscle.
A slipped rectus muscle may occur as a result of ophthalmic surgery or ocular trauma. We reviewed seven cases of slipped rectus muscles following retinal detachment surgery, strabismus surgery, or trauma. Diagnosis, etiology, treatment, and prevention are discussed.
Adolescent↗
Anterior nongranulomatous uveitis: a seasonal variation.
A review of 348 consecutive cases of nontraumatic uveitis seen in the Wills Eye Hospital emergency room between Jan 1, 1981, and Dec 31, 1981, was conducted. Patients who presented with an initial episode of anterior nongranulomatous uveitis, without obvious etiology by history or clinical examination, were further evaluated for epidemiologic clues suggestive of a pathogenesis. This group consisted of 121 patients. A statistical analysis for seasonal variation suggested an increased occurrence during the summer months (p .01).
Female↗