Ganciclovir intraocular device and patient survival.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
R F Spaide
Publications and source records attributed to R F Spaide.
The contralateral reduction of intraocular pressure by timolol.
Administration of timolol to one eye is associated with a decrease in intraocular pressure in both eyes. To further investigate this effect the contralateral decrease in intraocular pressure was measured in a three arm crossover study using a 0.1 mg dose of timolol given topically to an eye, a 0.1 mg dose of timolol given lingually, and a placebo given topically. Two hours after topical timolol administration the mean intraocular pressure reduction in the fellow eye was 3.1 mm Hg compared with baseline (p = 0.0007). Two hours after lingual timolol administration the mean intraocular pressure reduction was 3.9 mm Hg compared with baseline (p = 0.0004). Two hours after topical administration of placebo the mean intraocular pressure reduction in the fellow eye was only 0.33 mm Hg (p = 0.6). These findings suggest the contralateral reduction in intraocular pressure from timolol is caused by systemic absorption. The significant intraocular pressure reduction obtained from lingual timolol raises the possibility that this route of drug administration may be useful in selected patients who cannot use eye drops.
Administration, Topical↗
Subretinal exudative deposits in central serous chorioretinopathy.
The presence of subretinal exudation in a patient with neurosensory detachment of the macula frequently suggests the diagnosis of choroidal neovascularisation. A retrospective chart review of newly diagnosed cases of central serous chorioretinopathy revealed 11 patients, seven men and four non-pregnant women, who had plaques of subretinal exudate, which presumably were fibrin. Each of these patients had a solitary plaque that ranged in size from 300 to 1500 microns in diameter. These patients had no signs or a clinical course suggestive of choroidal neovascularisation. In each case the subretinal plaque was overlying an exuberant leak in the retinal pigment epithelium. The exudate was generally present at the initial examination, and usually showed dissolution before or coincident with the resolution of the neurosensory detachment. After resolution of the central serous chorioretinopathy, patients were left with subtle alterations in the retinal pigment epithelium in the areas of the subretinal plaque. These findings are important for two reasons. Firstly, the presence of subretinal exudation does not necessarily rule out the diagnosis of central serous chorioretinopathy. Secondly, pathophysiological theories of central serous chorioretinopathy must explain how the plaques are deposited behind the retina.
Adult↗
Chronic cystoid macular edema and predictors of visual acuity.
Of 141 patients who had clinically significant cystoid macular edema (CME) following cataract surgery, 42 had a visual acuity of 20/200 or worse. Logistic regression demonstrated that of all the systemic and ocular factors studied, the best predictors of visual acuity of 20/200 or worse were the presence of iris in the wounds (odds ratio = 2.86, P = .011) and a fluorescein angiogram grade of 4 (odds ratio = 2.91, P = .0076). Entering into the logistic regression variables such as integrity of the posterior capsule, iritis, vitreous in the wound, or type of intraocular lens did not significantly improve the ability of the model to predict which patients would have poor visual acuity. This study suggests that iris incarceration in the wound may have a more important association with poor vision in patients with chronic postsurgical CME than previously thought.
Aged↗
Orbital retractors for posterior segment surgery.
Successful retinal detachment surgery is greatly aided by proper visualization of and access to the intended surgical field. Two retractors, one having a single blade and the other a double blade, have been developed to aid retinal detachment surgery.
Humans↗
Orbital aspergillosis in an immunocompromised host.
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Acquired Immunodeficiency Syndrome↗
Frosted branch angiitis associated with cytomegalovirus retinitis.
We examined three patients with acquired immunodeficiency syndrome who had frosted branch angiitis associated with small patches of cytomegalovirus retinitis. Each patient had a low CD4-helper T-lymphocyte count and a T-lymphocyte helper-suppressor ratio of less than 0.1. Treatment with intravenous anticytomegalovirus antibiotics caused the vascular sheathing to resolve within two weeks in all three patients, but each patient continued to have a smoldering retinitis. Retinal biopsy in one of the patients demonstrated virions whose morphologic characteristics were consistent with cytomegalovirus on electron microscopy and the identity of which was confirmed by immunohistochemistry. Although frosted branch angiitis in otherwise healthy patients responds to corticosteroids, similar treatment with corticosteroids for frosted branch angiitis associated with cytomegalovirus retinitis in patients with AIDS does not seem to be indicated. Before corticosteroid treatment is started for a patient with the clinical signs and symptoms of frosted branch angiitis, careful medical examination of the patient is necessary.
Acquired Immunodeficiency Syndrome↗
Microrips of the retinal pigment epithelium.
We describe six patients with exudative age-related macular degeneration who had retinal pigment epithelial detachments with associated overlying neurosensory detachments. During fluorescein angiography, each patient demonstrated a solitary, intense, central serouslike leak at the edge of the retinal pigment epithelial detachment with passage of fluorescein into the subretinal space. In patients in whom the location of associated choroidal neovascularization was evident, the leakage site was remote to the area of neovascularization. Our observations suggest that these leaks result from small retinal epithelial rips, which we termed "microrips," that differ from conventionally described retinal pigment epithelial rips in clinical course and response to laser treatment. We hypothesize that the mechanisms and forces that generate these microrips are different from those producing conventionally described retinal pigment epithelial rips.
Aged↗
Epstein-Barr virus antibodies in multifocal choroiditis and panuveitis.
Although it has been reported that patients with multifocal choroiditis and panuveitis have serologic evidence of a chronic or persistent Epstein-Barr virus infection, our patients did not seem to have other stigmata of Epstein-Barr virus infection. To reappraise the serologic evidence of chronic Epstein-Barr virus infection, the Epstein-Barr antibody levels in 11 patients with multifocal choroiditis and panuveitis and 11 sex- and age-matched control patients were measured. Neither the antiviral capsid antigen IgG (P = .15) nor the antinuclear antigen (P = .2) antibody titers of the patients with multifocal choroiditis and panuveitis were significantly different than those of the control patients. Neither the patients with multifocal choroiditis and panuveitis nor the control patients had increased antiviral capsid antigen IgM titers. One patient with multifocal choroiditis and panuveitis and three control patients had positive anti-early antigen antibody titers (P = .59). The results of this study do not support the hypothesis that patients with multifocal choroiditis and panuveitis have serologic evidence of chronic or persistent Epstein-Barr virus infection as a characteristic finding.
Adult↗
Varicella-zoster virus retinitis in patients with the acquired immunodeficiency syndrome.
We examined five patients infected with the human immunodeficiency virus who developed a rapidly progressive necrotizing retinitis characterized by early patchy choroidal and deep retinal lesions and late diffuse thickening of the retina. In all but one case, the retinitis began in the posterior pole with little or no clinical evidence of vasculitis. All five patients had relentless progression of disease and were left with atrophic and necrotic retinae, pale optic-nerve heads, and narrowed vasculature. None of the patients developed aqueous or vitreal inflammation or retinal detachment. Clinical and laboratory evidence suggested that varicella-zoster virus was the causal agent in all five cases. First, the onset of retinitis in four cases either succeeded or was coincident with an eruption of dermatomal zoster. Second, varicella-zoster virus was cultured from the two chorioretinal specimens and varicella-zoster virus antigen was detected in the vitreal aspirate from one case. Third, by means of immunocytochemistry, varicella-zoster virus antigen was found in the outer retinae of both enucleation specimens. Fourth, viral capsids with the size and shape of herpesviridae were found in the outer retinae of both enucleation specimens. The clinical features observed in this study are distinct from those described for the acute retinal necrosis syndrome and appear to constitute a new and highly characteristic pattern of varicella-zoster virus-induced disease.
Acquired Immunodeficiency Syndrome↗
Linear streaks in multifocal choroiditis and panuveitis.
The clinical differentiation between multifocal choroiditis and panuveitis (MCP) and the presumed ocular histoplasmosis syndrome (POHS) can be difficult. Each condition is associated with peripapillary atrophy, chorioretinal spots, and subretinal neovascularization. Peripheral chorioretinal streaks have been described as the "fourth sign" of POHS. A consecutive series of patients with MCP were examined to determine the prevalence of peripheral chorioretinal streaks. Examination of 47 involved eyes in 25 patients revealed three eyes with streaks near the equator. These findings suggest that the presence of peripheral linear streaks cannot be used to differentiate the POHS from MCP.
Choroiditis↗
Choroidal vasculitis in acute posterior multifocal placoid pigment epitheliopathy.
A 24-year-old Caucasian female presented with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and associated infiltration round some of the larger choroidal blood vessels. This infiltration dissipated as the patient's clinical condition improved and did not induce any permanent alteration of the overlying retinal pigment epithelium. We suggest that the infiltration round the choroidal vessels was due to a choroidal vasculitis. The finding of choroidal inflammation in this case lends support to the hypothesis that choroidal vasculitis is an underlying pathological process in APMPPE.
Adult↗
Conjunctival biopsy in the diagnosis of sarcoidosis.
We prospectively studied 47 sarcoidosis suspects and compared conjunctival and transbronchial lung biopsies in these patients. Thirty-four patients had positive findings on biopsy by either method. The transbronchial biopsy was positive in 31 patients, and the conjunctival was positive in 19. The transbronchial lung biopsy was more likely to be positive in black patients (p = 0.009) and in patients with pulmonary infiltrates on chest x ray (p = 0.0044). In comparison, the conjunctival biopsy was more likely to be positive in patients with conjunctival follicles (p = 0.036), ocular abnormalities consistent with sarcoidosis (p = 0.02), and in patients with pulmonary infiltrates on chest x ray (p = 0.029). Iritis was present in 12 patients, enlarged lacrimal glands in three, and vitritis in five. We conclude that the conjunctival biopsy is an effective means of diagnosing sarcoidosis and that every sarcoidosis patient should have an ophthalmic examination.
Adult↗
Lack of the HLA-DR2 specificity in multifocal choroiditis and panuveitis.
The prevalence of the HLA-B7 and HLA-DR2 specificities in 17 unrelated patients with multifocal choroiditis and panuveitis, 11 with and six without subretinal neovascularisation, was evaluated and compared with those of two different groups. The first group was 17 patients with subretinal neovascularisation associated with presumed ocular histoplasmosis syndrome, and the second was a group of 105 eye patients with no retinal disease. HLA-DR2 was not found in any patient with multifocal choroiditis and panuveitis, but it was found in 13 patients with presumed ocular histoplasmosis syndrome (p = 6.72 x 10(-5), comparison of the groups with subretinal neovascularisation). The lack of HLA-DR2 was also significant in comparison with the control group of eye patients (p = 0.041). This study suggests that patients with multifocal choroiditis and panuveitis and presumed ocular histoplasmosis syndrome have differing genetic predispositions, though the fundus pictures in these entities have many similarities.
Adult↗
Idiopathic polypoidal choroidal vasculopathy (IPCV).
Eleven patients, 40 to 71 years old, had a choroidal vasculopathy that led to hemorrhagic and exudative macular degeneration. The patients had peculiar polypoidal, subretinal, vascular lesions associated with serious and hemorrhagic detachments of the retinal pigment epithelium. This macular disorder, which we have named idiopathic polypoidal choroidal vasculopathy (IPCV), appears to represent a distinct entity that differs clinically and demographically from age-related macular degeneration (AMD) and other macular diseases associated with subretinal neovascularization. Recognition of this condition is important because it may have specific risk factors, natural course, and management considerations that differ from those of age-related macular degeneration.
Adult↗
Shaken baby syndrome.
Violent shaking causes severe injury in infants, but the diagnosis of shaken baby syndrome is often difficult to make because of the lack of obvious external signs. Consultations by other specialists may not be helpful, since the findings of most organ systems, taken in isolation, are usually nonspecific. Shaken baby syndrome should be considered in infants presenting with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, hypothermia, bradycardia, hypertension or hypotension, respiratory irregularities, coma or death. Shaken babies are usually less than one year old, and most are under six months of age. Head injury (notably subdural hemorrhage) and retinal hemorrhages are the hallmarks of the syndrome.
Brain Concussion↗
Rapidly expanding exophthalmos: an unusual presentation of small cell lung cancer.
A 61-year-old male presented with a rapidly progressive exophthalmos from small cell lung cancer metastatic to the right orbit. His vision in that eye was 20/200, and his intraocular pressure was 36 mmHg. The orbital metastasis responded dramatically to chemotherapy. One week after starting the chemotherapy the patient did not have exophthalmos, his vision was 20/20, and three weeks later the intraocular pressure was 12 mmHg.
Antineoplastic Combined Chemotherapy Protocols↗
Who knows how much a cataract extraction costs? .
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Cataract Extraction↗