Clostridium perfringens endophthalmitis.
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Biomedical subjects
Publications and source records attributed to C H Ide.
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We conducted a randomly assigned, double-masked, controlled clinical trial to assess the efficacy of 1% apraclonidine hydrochloride in controlling postoperative intraocular pressure increases in patients undergoing extracapsular cataract extraction. Apraclonidine hydrochloride was given either one hour preoperatively or immediately after uncomplicated, extracapsular cataract extraction with posterior chamber intraocular lens implantation and compared with artificial tears given immediately postoperatively. Those who received apraclonidine hydrochloride preoperatively had significantly lower mean intraocular pressure at the first postoperative reading (P = .0005). After preoperative and postoperative apraclonidine hydrochloride, the mean early postoperative intraocular pressure was 19.8 mm Hg and 32.0 mm Hg, respectively, and 27.6 mm Hg after artificial tears. No patient who received preoperative apraclonidine hydrochloride had an intraocular pressure increase to 30 mm Hg or higher postoperatively. Nine of 20 patients (45%) who received postoperative apraclonidine hydrochloride and eight of 18 patients (44%) who received postoperative artificial tears had an increase of intraocular pressure to 30 mm Hg or higher in the early postoperative period. These differences were also highly significant (P = .0005).
The effect of acquired optociliary veins on visual acuity after ischemic central retinal vein occlusion in patients 45 years of age or older was assessed retrospectively. Fundus photographs and medical records of 21 patients, 45 years of age or older, with photographically documented central retinal vein occlusion and at least six-months follow-up were analyzed. Eleven of 21 patients developed acquired optociliary veins. Patients with acquired optociliary veins were more likely to experience stable or improved visual acuity (nine of 11 patients) than were patients without them (four of ten patients) over a mean follow-up period of 30 months (P = .049).
We conducted a randomized, double-masked study of intraocular pressure in 80 patients treated with betaxolol, levobunolol, timolol, or placebo after extracapsular cataract extraction. Intraocular pressures were measured preoperatively and early (four to seven hours) and late (20 to 24 hours) postoperatively. There was a significant mean increase in pressure from the preoperative period to the early postoperative period for the placebo group (5.35 mm Hg), betaxolol group (6.73 mm Hg), and the timolol group (3.83 mm Hg). However, the levobunolol group had a mean decrease in pressure (0.43 mm Hg). There was no significant difference between preoperative and late postoperative pressures for any of the groups. One-way analysis of covariance of the changes in pressure from the preoperative to early postoperative period showed a significant increase for the placebo and betaxolol groups compared to the levobunolol group, without significant difference between the levobunolol and timolol groups. Overall, levobunolol proved most effective in preventing an increase in intraocular pressure after extracapsular cataract extraction; timolol was partially effective.
A new method allows accurate testing of visual function behind mild-to-moderate cataracts or capsular opacities. Patients were asked to compare the number of corpuscles visualized with the blue field entoptoscope with a series of projected slides having progressively fewer drawn corpuscles. To standardize the equipment, the test was performed on 69 patients with varying degrees of macular impairment. Of the patients who selected 120 corpuscles or more, 89% had visual acuities of 20/40 or better, and those who selected 100 corpuscles or less, 82% had visual acuities of 20/50 or worse. The percentages were higher for age-related macular degeneration (ARMD) patients (100 and 85%) than for diabetic patients (33 and 75%). The same apparatus was then used to predict the potential visual acuity in 56 preoperative cataract or YAG-capsulotomy patients. Of the 23 patients with a preoperative acuity of 20/200 or better and who selected 120 corpuscles or more, 100% were 20/40 or better postoperatively.
Tangier disease, or familial high-density lipoprotein deficiency, is an inherited disorder resulting in tissue deposition of excessive cholesterol esters. Although associated corneal clouding has been reported to produce little visual impairment, this patient with Tangier disease had corneal clouding, decreased corneal sensation, and cicatricial ectropion and experienced slowly progressive marked visual impairment. All ocular cases of Tangier disease are reviewed. Ectropion and incomplete eyelid closure may precede corneal clouding and should be recognized as signs associated with Tangier disease. The combination of exposure keratopathy and corneal infiltration can cause significant visual impairment.
A twenty-two-year-old woman with a history of long-Standing retinitis pigmentosa and recently discovered bilateral exudative retinal detachments of the Coats' type is described. This widely unrecognized association has been reported to occur in up to 2% of patients with retinitis pigmentosa. Unlike the usual Coats' syndrome, it is more often bilateral, shows no sex preference and occurs in older individuals. Heightened awareness of this potentially treatable complication of retinitis pigmentosa may facilitate earlier recognition of the problem, which may lead to more timely treatment and a better prognosis.
Self-enucleation or oedipism is a specific manifestation of psychiatric illness distinct from the milder forms of self-inflicted ocular injury. In this article, we discuss the previously unreported medical complication of subarachnoid hemorrhage accompanying self-enucleation. The diagnosis was suspected from the patient's history and was confirmed by computed tomographic scan of the head. This complication may be easily missed in the overtly psychotic patient. Specific steps in the medical management of self-enucleation are discussed, and medical complications of self-enucleation are reviewed.
Induced prolonged complementary chromatopsia in four subjects (two men, 26 and 34 years old, and two women, 34 and 45 years old) was documented by abnormal responses to pseudoisochromatic color plates 30 minutes after cessation of monochrome video display terminal use. This phenomenon was unrelated to preexisting color vision anomalies, known ocular disease, or drug use, and defines a specific phenomenon probably related to afterimages. All four patients missed AOH-R-R plate 3 after using the video display terminal. One patient also had a delayed response to plate 6. One patient patched one eye before using the video display terminal and noted that the complementary chromatopsia occurred only in the unpatched eye.
Blepharoconjunctivitis caused by methicillin-resistant strains of Staphylococcus epidermidis occurred in two hospitalized patients, a 74-year-old man and a 19-year-old man. Both strains were resistant to multiple courses of topical antibiotic therapy. Successful treatment in both cases depended upon antibiotic sensitivity testing. These methicillin-resistant strains of S. epidermidis, like methicillin-resistant strains of Staphylococcus aureus, demonstrated almost complete cross-resistance to cephalosporins despite apparent sensitivity on Kirby-Bauer disk sensitivity testing. Topical vancomycin was curative in one case. In the other case, treatment with topical gentamicin, intravenous cefoperazone, and oral rifampin led to resolution of the symptoms.
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Retinal studies were done in 181 postpubescent, insulin-dependent diabetic patients who developed diabetes before the age of 20. Retinal studies included serial direct ophthalmoscopic examinations, stereoscopic fundus photography and fluorescein angiography. At the time of retinal studies, muscle biopsies also were done to measure capillary basement membrane thickness (CBMT) as an index of early microvascular changes in skeletal muscles. Assessment of clinical metabolic control, interpretation of retinal findings, and CBMT were done independently. No retinopathy was detected in patients observed continuously and known to have been in higher degrees of metabolic control. Twenty-five patients in lower degrees of control for extended periods had retinopathy. CBMT was found to be labile and to progress or regress within a year depending on the degree of control. All patients in lower degrees of control with retinopathy had increased CBMT, but if they subsequently attained and maintained a high degree of control for a year, then CBMT diminished and there was no progression of retinopathy. Our study demonstrates that a high degree of metabolic control delays, and may prevent, microvascular changes, and confirms other studies indicating that most postpubescent, insulin-dependent diabetic patients will develop retinopathy within 15 years unless a relatively high degree of control is maintained.
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An orbital teratoma with extension into the maxillary sinus, pterygopalatine fossa nasal cavity, and middle cranial fossa is presented. Through combined efforts of the services of Ophthalmology, Otolaryngology, and Neurosurgery, a tumor that was 4.5 cm in greatest diameter was removed, leaving the globe and optic nerve within the orbit. Within the 2 1/2-year period since surgery, the condition of the patient has been satisfactory.
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A case of acrodermatitis enteropathica is presented that is the first to manifest punctal stenosis, the fourth to show corneal changes, and the sixth to survive into adulthood.
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