Cytomegalovirus retinitis.
Explore the source record for details and available documents.
AIDS-Related Opportunistic Infections↗
Biomedical subjects
D C Bright
Publications and source records attributed to D C Bright.
Case presentations of retinal artery occlusions.
BACKGROUND: Retinal artery occlusions typically result in sudden, unilateral painless loss of vision and may have varying presentations. They are associated with systemic diseases such as atherosclerosis, hypertension, and valvular heart disease. Additional risk factors include diabetes mellitus, cigarette smoking, giant-cell arteritis, and hyperlipidemia. They most often occur in persons 60 to 80 years of age. METHODS: Four patients have come to our clinics with varying degrees of visual loss as a result of retinal artery occlusions. The types of arteriolar occlusions presented include: precapillary arteriole occlusion, cilioretinal artery occlusion, branch retinal artery occlusion, and central retinal artery occlusion. RESULTS: Patients were followed for their ocular involvement, but also included was medical management of the underlying systemic disease condition. Workup of retinal artery occlusion included laboratory testing, carotid duplex scans, and echocardiograms to uncover the possible systemic etiologies of the artery occlusion. CONCLUSION: Optometrists should recognize the signs and symptoms of the various arterial obstructions and refer patients for systemic treatment as indicated. Patients who manifest retinal or pre-retinal artery occlusions should undergo thorough systemic evaluations for vascular disease, including: atherosclerotic disease, hypertension, and valvular heart disease.
Aged↗
Antiretroviral therapy for HIV infection: a review of current medications and therapies.
BACKGROUND: Management of HIV infection has been revolutionized in the past 3 years by the introduction of drugs significantly more potent than those previously available. Simultaneously revelations about dynamics of HIV infection and viral replication have altered concepts about HIV disease, as well as the need for therapeutic interventions. METHODS: A literature search was conducted of journals listed in the Index Medicus, as well as abstracts from annual meetings of the American Society for Microbiology, the Infectious Disease Society of America (Conference on Retroviruses and Opportunistic Infections), and the International Conferences on AIDS. RESULTS: Antiretroviral drugs of four differing pharmacologic classes are able to achieve profound suppression of viral replication when combined in varying regimens. Costs of medications remain high, many toxicities are associated with drug therapy, and regimens are both complex and daunting. In spite of many difficulties associated with highly active anti-retroviral therapy (HAART), many patients are able to achieve improved quality of life and longer survival. CONCLUSIONS: Optometrists, as members of the health care team, play a role in diagnosis and management of HIV patients, in providing encouragement and empathy to patients--particularly emphasizing the need for adherence to complex therapy regimens, as well as the importance of regular followup.
Anti-HIV Agents↗
Acute vision loss resulting from complications of ethanol abuse.
BACKGROUND: Alcoholism affects about 10% of men and 3% to 5% of women in their lifetime. It is a primary chronic disease with genetic, psychosocial, and environmental factors that influence its development and manifestations. METHODS: A 47-year-old alcoholic male manifested mild nutritional optic atrophy, chronic anemia, pancreatitis, and previous gastrojejunostomy and pancreaticojejunostomy. After an acute episode of hypovolemic blood loss from peptic ulceration, there was increased bi-temporal optic nerve head pallor with permanent vision loss, central scotoma, and an acquired red-green color vision defect. RESULTS: The genetic, psychosocial, and systemic effects of ethanol abuse--including anemia, cardiomyopathy, gastric/duodenal ulceration, pancreatitis, and neurologic deficits--are reviewed. Appropriate treatment and management of ocular manifestations and complications from alcoholism are discussed. Prophylactic topical therapy may be indicated to restore the balance between intraocular tension and optic nerve head perfusion in an attempt to prevent further axonal loss. CONCLUSION: Alcohol-induced nutritional optic neuropathy should not be viewed as an isolated ocular entity, but rather as a potentially treatable neurologic problem. An interdisciplinary approach is essential optimal in the management of the alcoholic patient.
Acute Disease↗
Pharmacologic management of cytomegalovirus retinitis: review of current and future therapeutic modalities.
BACKGROUND: A number of new medications and modes of drug delivery have been introduced for the management of cytomegalovirus (CMV) retinitis in AIDS patients. New modes of treatment have attempted to prolong intervals between dosing and reduce drug-related toxicity in an effort to improve quality of life. METHODS: The ophthalmic, infectious disease, and pharmacologic literature were reviewed and evaluated for trends and new approaches to the management of CMV retinitis. RESULTS: Ganciclovir and foscarnet have been the mainstays in management of CMV retinitis. Intravenous administration of these drugs is costly, time-consuming, and complicated by numerous toxicities. Changes in the delivery of anti-viral drugs have involved intravitreal injections and implant devices. Other new methods involve liposomal systems to increase drug contact time, use of longer-acting drugs with less-frequent dosing requirements, and methods to improve quality of life by avoiding intravenous drug delivery. CONCLUSIONS: A number of strategies have evolved to manage cytomegalovirus retinitis. Patients are living longer with AIDS. With increased survival comes increased risk of CMV retinitis and the need for more-effective treatments to preserve retinal integrity. The optometrist must become aware of the potential of these drugs to control retinitis, protect functional vision, and maintain quality of life.
AIDS-Related Opportunistic Infections↗
Optometric management of patients with Alzheimer's disease.
BACKGROUND: The earliest symptoms of Alzheimer's disease (AD) may be visual. AD is an age-related, progressive dementia. At least 7% of Americans over 65 years of age are afflicted, and it ranks as the fourth leading cause of death in the United States. A review of the literature was performed to delineate the visual manifestations of Alzheimer's disease. RESULTS: Abnormal visual perception and visuospatial processing are common among patients with AD Visual acuity, pupillary light reflexes, and the ocular fundus do not appear to be specifically affected by AD. Whether AD impairs color vision is controversial. Stereopsis may also be affected. True visual-field defects are rarely found. Although not universally reported, some studies of contrast sensitivity functions show abnormal sensitivity possibly at low spatial frequencies. The electroretinogram is normal, while the visual evoked response is frequently abnormal. CONCLUSIONS: As primary eye care providers, optometrists must properly identify and refer individuals with suspected Alzheimer's disease to the appropriate specialist, as well as manage their visual welfare.
Aged↗
Traumatic porencephalic cyst of the brain.
BACKGROUND: A porencephalic cyst is a cavity within the cerebral hemisphere, filled with cerebrospinal fluid, that communicates directly with the ventricular system. It is a rare condition probably caused by vascular occlusion resulting from an insult during fetal development or an injury occurring later in life. Porencephaly is often associated with various ophthalmic and neurologic signs, including visual-field defects, abnormal pupillary responses, optic nerve hypoplasia, decreased vision, nystagmus, strabismus, hemi-inattention, seizures, and mental deficiencies. CASE REPORTS: Two cases are presented of patients in whom porencephalic cysts developed as a result of traumatic head injuries. Both had demonstrable visual-field defects, with diagnosis of porencephaly verified by computed tomography scans of the head. CONCLUSIONS: Visual-field defects resulting from porencephalic cysts can mimic those observed with strokes or brain tumors. A thorough case history and complete neurologic workup can assist with differential diagnosis. The clinical features of porencephaly, different theories of brain recovery after trauma, and treatment options are discussed.
Adult↗
Colloid cyst of the third ventricle.
BACKGROUND: Colloid cyst of the third ventricle has rarely been reported in the ophthalmic literature. The incidence is about one per 1000 in asymptomatic patients and accounts for 0.55 to 2 percent of all intracranial tumors. Although it is an uncommon benign tumor, nearly half of symptomatic patients present with papilledema and hydrocephalus. Consideration of this intracranial tumor should be included in the differential diagnosis of papilledema and apparent unilateral disc edema. METHODS: A patient with highly asymmetrical papilledema and vague visual symptomatology involving the right eye was studied. Computer axial tomography (CT) without contrast enhancement revealed a colloid cyst of the third ventricle. Typical symptoms of the condition include headaches, nausea, vomiting, visual obscuration, transient diplopia and weakness of the lower extremities, which are due to acute hydrocephalus caused by increased intracranial pressure from cystic obstruction of the foramen of Monro. Intermittency of symptoms is characteristic of this lesion. RESULTS: The patient underwent frontal craniotomy with total tumor excision and reopening of the cerebrospinal fluid pathway. CONCLUSIONS: Colloid cyst of the third ventricle discovered incidentally on CT in asymptomatic patients with no evidence of hydrocephalus can be monitored periodically. If symptomatic, neurosurgery is usually indicated since prolonged increased intracranial pressure can lead to mental and physical deterioration as well as sudden death.
Brain Diseases↗
Presumed ocular tuberculosis in an AIDS patient.
BACKGROUND: Prior to the advent of anti-tuberculosis medications, ocular manifestations of tuberculosis, including choroidal tubercles, were common. METHODS: A 46-year-old Hispanic male with a history of AIDS, tuberculosis and treated neurosyphilis presented for examination complaining of decreased vision in the left eye. Ophthalmoscopy revealed a large, elevated, juxtapapillary lesion consistent with a choroidal tubercle or an intraocular lymphoma. RESULTS: During follow-up, the lesion responded well to systemic anti-tuberculosis therapy. CONCLUSIONS: With the recent increase in incidence of tuberculosis in both th general population and AIDS patients, ocular manifestations of tuberculosis once thought to be rare may be increasing. Ocular tuberculosis should be considered in the differential diagnosis of patients presenting with intraocular masses, especially in individuals at high risk for exposure.
Acquired Immunodeficiency Syndrome↗
Retinal nerve fiber layer defects and microtalc retinopathy secondary to free-basing "crack" cocaine.
BACKGROUND: There have been several reports in the literature documenting ocular manifestations of cocaine abuse. None have discussed the potential retinal complications stemming from cocaine inhalation. METHODS: Approximately 60 patients with a history of free-basing "crack" cocaine were examined at the Optometry Clinic. Threshold visual field testing and fundus photographs were obtained and later reviewed. RESULTS: Microtalc retinopathy and associated retinal nerve fiber layer "rake" or "slit" defects were detected exclusively in patients who had free-based "crack" cocaine. Some of these patients manifested visual field changes that mimic glaucoma. Several cases are presented that demonstrate the findings typical of those observed in the patients examined at the Optometry Clinic. CONCLUSIONS: Microtalc retinopathy and associated glaucoma-like retinal nerve fiber layer defects indicate the presence of permanent microvascular changes in the eyes, as well as the lungs, brain, and probably other peripheral organs. Optometrists should be aware of these new findings in order to properly manage patients who free-base "crack" cocaine.
Adult↗
Papilledema secondary to metastatic prostate disease.
BACKGROUND: Prostate cancer increases in incidence with age, and is common in older men. If allowed to progress or detected late, prostate cancer readily metastasizes to bone and accounts for about 11 percent of all cancer deaths. Associated conditions with prostate metastatic disease are anemia, pathological bone fractures, and paraplegia. Occasionally, prostate cancer may metastasize to the skull or spinal cord and result in papilledema. Two cases presenting with papilledema secondary to metastatic prostate disease are discussed.
Adenocarcinoma↗
Malignant melanoma of the choroid with literature review.
A 67-year-old white male presented for an eye examination with history of difficulty reading. Upon routine dilation, an unsuspected malignant melanoma of the choroid was discovered. Binocular indirect ophthalmoscopy, B-scan ultrasonography, and visual field testing helped confirm the initial diagnosis. Uveal malignant melanoma is the most common primary intraocular malignant tumor occurring in adults. Controversial issues regarding proper management of choroidal malignant melanoma are discussed.
Aged↗
Traumatic optic neuropathy complicated by thyroid eye disease.
BACKGROUND: Thyroid eye disease is the most common orbital disorder found in adults. Ocular changes may occur with or without systemic hyperthyroidism. Blunt orbital trauma can affect the eye in many ways and can confound and alter the natural course of thyroid eye disease. METHODS: A 76-year-old patient with a number of ophthalmic findings and associated symptoms which could have been related to previous blunt ocular trauma. Careful optometric evaluation, systemic laboratory testing, and review of the ocular and medical findings demonstrated the onset of thyroid dysfunction. RESULTS: Thyroid disease was diagnosed on the basis of the presence of enlarged extraocular muscles by CT scan and elevated tensions on attempted upgaze. The patient demonstrated an elevated T3 uptake and low TSH levels for which he was treated with propylthiouracil. The occurrence of thyroid disease and damage from blunt trauma confounded the diagnosis because forced duction testing and optic atrophy could well have been the result of previous blunt trauma. CONCLUSIONS: This case elucidates the many differential diagnoses and complications that result from the combination of previous blunt trauma and the occurrence of new thyroid disease with ophthalmic findings.
Aged↗
Superior quadrant visual field loss secondary to temporoparietal craniectomy for brain abscess.
BACKGROUND: Visual field defects occur from a variety of causes. As a result, the differential diagnosis of visual field defects and their etiology is important. METHODS: A 64-year old white male was examined in follow up related to the surgical removal of a right temporal lobe abscess secondary to a childhood right side mastoidectomy. The patient underwent ophthalmic examination, which suggested possible changes in his field of vision, and neurobehavioral evaluation related to his visual field defect, a left homonymous superior quadrant defect. RESULTS: Computed tomography (CT) scan of the head without contrast enhancement confirmed the ophthalmic diagnosis and correlated with the patient's medical history. However, neurobehavioral evaluation revealed a number of deficits that were believed to be associated with alcohol abuse. CONCLUSIONS: Visual field loss with changing vision symptoms and a complex history can confound the differential diagnosis of visual field defects. Frequently careful and complete evaluation can confirm and reveal subsequent diagnoses.
Brain Abscess↗
Support for the vasogenic theory of glaucoma: case reports and literature review.
BACKGROUND: The influence of systemic disease, vascular abnormalities, hematologic and rheologic factors, pulsatile ocular blood flow, perfusion pressure, autoregulation, optic disc hemorrhage and the results of optic nervehead fluorescein angiographic studies are reviewed in the context of supporting evidence for the vasogenic theory of glaucoma. METHODS: Two case reports of patients with confirmed carotid artery occlusive disease and one case report of a patient with a history of hypovolemic blood loss are presented. RESULTS: These cases illustrate the importance of hypotensive crisis, perfusion pressure, collateral blood flow and the optic nerve head vascular autoregulatory mechanism in the pathogenesis of glaucoma and the differential diagnosis of pseudoglaucoma. CONCLUSIONS: Evaluation and consideration of both mechanical and vasogenic causes of the glaucomas is essential in the management of the glaucomas. It is also necessary to differential diagnose the "pseudo-glaucomas," and to manage them correctly.
Aged↗
Visual field loss secondary to radiation-induced cerebral necrosis.
Radiation-induced cerebral necrosis has been well documented in the literature. Because radiation induced cerebral necrosis can occur to any part of the central nervous system that falls within the irradiated area, the visual pathway is highly susceptible to damage as it passes from the eye to the visual cortex. With proper visual field testing and interpretation, optometrists may serve as primary diagnosticians in radiation-induced cerebral necrosis and actively participate in the long-term management of these patients. This case presents a patient with visual field loss secondary to a temporal lobe lesion whose etiology was thought to be radiation-induced. The incidence, pathophysiology, and clinical features of radiation-induced cerebral necrosis as well as other differential diagnoses are discussed.
Aged↗
Dermatologic conditions of the eyelids and face.
As public concern increases about the effects of light radiation and skin cancer of all types, the primary care optometrist becomes increasingly involved in screening for dermatologic changes of the face, eyelids, and periorbital area. Often faced with a lesion of unknown identity, the optometrist is concerned with both identifying that lesion and assessing its potential for malignancy, particularly in the increasingly litigious environment surrounding health care. Compounding the difficulties of recognition are multiple variations in morphologic features, which contribute to frequent misdiagnoses. The main purposes of this paper are to: (1) expand the optometrist's knowledge of characteristic features of dermatologic lesions, (2) present the differential diagnoses of similar or mimicking lesions, (3) improve the recognition of characteristics that suggest malignancy or malignant transformation of precursor lesions, and (4) enhance awareness of individual risk factors for the development of skin cancer.
Diagnosis, Differential↗
Goldmann applanation tonometry without fluorescein.
Recently, there have been several suggestions that Goldmann applanation tonometry can be performed without fluorescein. In order to determine the clinical efficacy of performing Goldmann applanation tonometry without fluorescein, 100 consecutive patients had applanation tonometry performed without fluorescein (Ophthetic only) and with fluorescein (Fluress), according to a predetermined randomization schedule. It was found that the average difference between readings with fluorescein and without fluorescein was 7.01 mm Hg. Tonometry readings without fluorescein were lower than readings with fluorescein. In addition, regression analysis indicated that the differences between the readings with and without fluorescein increased as intraocular pressure increased. By not utilizing fluorescein in Goldmann applanation tonometry, the clinician will record lower readings. In addition, greater errors in measurement occur with increasing intraocular pressures. Because eyes with higher intraocular pressures are at a greater risk to develop glaucomatous optic atrophy and loss of visual field, the merits of Goldmann applanation tonometry without fluorescein are speculative.
Fluoresceins↗