Dense premacular hemorrhage from a retinal macroaneurysm treated by argon laser.
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Aged↗
Biomedical subjects
R S Moorthy
Publications and source records attributed to R S Moorthy.
Corticosteroids as an antiangiogenic agent for histoplasmosis-related subfoveal choroidal neovascularization.
The purpose of this study was to evaluate the role of corticosteroids in managing subfoveal choroidal neovascularization (CNV) secondary to the presumed ocular histoplasmosis syndrome. The cases of eighteen patients with histoplasmosis-related subfoveal CNV treated with corticosteroids were reviewed. Ten patients received oral prednisone for 4 to 6 weeks, and eight received a single sub-Tenon's injection of triamcinalone. Visual acuity outcomes were analyzed along with side effect profiles. At two-week follow-up, the prednisone group showed a median improvement in Snellen visual acuity of +2.0 lines, while the triamcinalone group remained essentially stable with a 0.5 line median loss. At treatment end (4 to 6 weeks), both groups showed no significant change in median acuity at 0.0 and -1.0 lines, respectively. Median final vision at 3 months also remained essentially stable at -0.5 lines for each group. Three patients reported anxiety, all of whom were taking prednisone 80 mg daily. Two patients reported increased appetite and weight gain on regimens of prednisone 80 and 100 mg daily. There were no adverse effects reported in the other patients receiving oral prednisone or in any patient receiving sub-Tenon's triamcinalone. The results suggest a beneficial effect of corticosteroids in stabilizing subfoveal CNV secondary to ocular histoplasmosis. In this small series, oral prednisone resulted in a short-term improvement in visual acuity, which stabilized over longer follow-up. The sub-Tenon's triamcinalone group achieved similar final stabilization without the initial improvement. Corticosteroids may be particularly valuable in managing neovascularization in patients who are awaiting interventions currently under development, in preventing recurrence after subfoveal surgery, or in treating non-surgical candidates. Further study is warranted to define the precise role of corticosteroids in this condition.
Administration, Oral↗
Ocular toxicity associated with systemic drug therapy.
Systemic drug-induced ocular side effects are increasing because of the vast numbers of new drugs being introduced. Reports of drug-induced ocular toxicity must be well documented, and other causes of these side effects must be ruled out to help establish causality. We reviewed the most recent reports of the most commonly used and newest systemic drugs that have been implicated in ocular toxicity. Using toxicologic criteria needed to establish causality, data from reports of ocular toxicity associated with systemic cidofovir (Vistide), sildenafil (Viagra), vigabatrin (Sabril), tamoxifen (Nolvadex), hydroxychloroquine (Plaquenil)/chloroquine (Aralen), amiodarone (Cordarone), and lovastatin (Mevacor)/simvastatin (Zocor) were evaluated and summarized. The probability for causality was determined to be high for all these drugs except for vigabatrin and lovastatin/simvastatin. Methods for detecting, preventing, and treating ocular toxic reactions were then reviewed for each drug.
Antineoplastic Agents↗
Idiopathic polypoidal choroidal vasculopathy of the macula.
OBJECTIVE: The authors evaluated the clinical, fluorescein, and indocyanine green (ICG) angiographic characteristics of the macular variant of idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Observational case series. PARTICIPANTS: The records, photographs, and fluorescein and ICG angiograms of eight eyes of seven patients with IPCV lesions confined to the macula were reviewed. MAIN OUTCOME MEASURES: The visual acuity, fundus examination, fluorescein and ICG angiographic characteristics, and clinical course were compared. RESULTS: All patients demonstrated polypoidal lesions arising from macular choroidal vessels on ICG angiography. One patient had bilateral lesions. These lesions appeared hyperfluorescent in the early phases of both fluorescein and ICG angiography. Late-phase leakage was seen in cases associated with subretinal fluid or exudate. None of these patients demonstrated polypoidal lesions arising from the peripapillary choroidal circulation or peripapillary choroidal neovascularization. Three eyes with polypoidal lesions that were associated with subretinal fluid and exudates were treated with photocoagulation. Five eyes were not treated. Final visual acuity ranged from 20/20 to hand motions. Severe visual loss was associated with vitreous and subretinal hemorrhage, but this resolved without permanent severe visual loss in several cases. CONCLUSIONS: In the macular variant of IPCV, ICG and fluorescein angiography demonstrate characteristic macular polypoidal lesions without evidence of peripapillary lesions. The vascular origin of these polypoidal lesions appears to be the macular choroidal circulation. This is distinguished from classic IPCV, in which lesions appear to arise from the peripapillary choroidal circulation. Visual prognosis appears to be good, with most patients retaining visual acuity of 20/80 or better. If subretinal fluid or exudates reduce visual acuity, photocoagulation should be considered.
Aged↗
Management of varicella zoster virus retinitis in AIDS.
AIMS/BACKGROUND: Varicella zoster virus retinitis (VZVR) in patients with AIDS, also called progressive outer retinal necrosis (PORN), is a necrotising viral retinitis which has resulted in blindness in most patients. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS. METHODS: A review of the clinical records of 20 patients with VZVR from six centres was performed. Analysis of the clinical characteristics at presentation was performed. Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir was carried out. RESULTS: Median follow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Median initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light perception at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarnet therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051). CONCLUSIONS: This study represents the second largest series, the longest follow up, and the first analysis of visual outcomes based on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relatively ineffective in treating this disease.
AIDS-Related Opportunistic Infections↗
Cystoid macular edema due to cytomegalovirus retinitis in a patient with acquired immune deficiency syndrome.
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AIDS-Related Opportunistic Infections↗
Microhemodynamics of retinal collateral vessel formation.
Retinal collaterals are a common clinical occurrence after branch vascular occlusions in humans and laboratory animals, yet the etiology and functional significance of these vessels is uncertain. A hypothesis is presented which attempts to explain the difficult problem of retinal arterial collateral circulation. This theory is consistent with microcirculatory hemodynamic research which demonstrates that microcirculatory flow determinants are primarily guided by resistance factors and vascular geometry. Testing with a simple mathematical model and SPICE simulation of a circuit model suggests this theory can be applied to cases of both arterial and venous collaterals. While the underlying determinants of flow can be described, the exact mechanisms of vascular remodelling into large caliber vessels must be primarily cellular.
Animals↗
Association between Vogt-Koyanagi-Harada syndrome and HLA-DR1 and -DR4 in Hispanic patients living in southern California.
BACKGROUND: Vogt-Koyanagi-Harada (VKH) syndrome is associated with human leukocyte antigen (HLA)-B54, -DR4, -DR beta 1*0405, -DQ4, and -DR53 in Japanese patients. Disease-associated HLA specificities may differ among races. This study examined HLA associations with VKH syndrome in Hispanic patients living in southern California, a racial subgroup at increased risk for the disease. METHODS: Human leukocyte antigen specificities were determined on 25 Hispanic patients with VKH syndrome and compared with HLA specificities of 217 healthy Hispanic control subjects. Inclusion criteria for study patients were nontraumatic panuveitis with exudative retinal detachments, with or without extraocular manifestations. Tests were performed using standard cytotoxic assays. RESULTS: HLA-DR4 was present in 14 (56%) patients with VKH syndrome and in 62(29%) control subjects (relative risk = 1.96). HLA-DR1 was present in 9 (36%) patients with VKH syndrome and in 19 (9%) control subjects (relative risk = 4.11). HLA-DR1 and DR4 share a common epitope within the DR beta 1 gene. HLA-DR1 and/or DR4 were present in 21 (84%) patients with VKH syndrome and in 76 (35%) control subjects (relative risk = 2.40). CONCLUSIONS: HLA-DR1 and -DR4 were found in a significantly disproportionate number of Hispanic patients with VKH syndrome living in southern California. HLA-DR4, although not HLA-DR1, has been previously associated with VKH syndrome in other groups. These associations suggest a common immunogenic predisposition to VKH among different racial groups, and suggest that a common epitope shared by DR1 and DR4 may be involved in the pathogenesis of the disease.
California↗
Vogt-Koyanagi-Harada syndrome.
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Diagnosis, Differential↗
Combination treatment of intraocular lymphoma.
BACKGROUND: Primary intraocular lymphoma is an uncommon clinical entity with poor visual and systemic prognosis. Optimal management of intraocular lymphoma remains uncertain. METHODS: Three patients with intraocular lymphoma, two of whom had documented CNS involvement, were treated based on a modification of the Sloan-Kettering Cancer Center protocol for primary CNS lymphoma. All patients underwent diagnostic pars plana vitrectomy and histopathologic confirmation of primary intraocular large B-cell lymphoma. Treatment involved systemic chemotherapy with methotrexate and high-dose ARA-C, radiation therapy of the brain and orbits, and intrathecal methotrexate delivered via an Ommaya reservoir. RESULTS: Resolution of the ocular lymphoma was seen in all three patients, and resolution of the intracranial disease also was seen in the two patients with CNS involvement. All patients have remained disease free, with lymphoma in remission for at least 24 months after completion of treatment. CONCLUSION: The Sloan-Kettering protocol for the treatment of primary CNS lymphoma also appears to be effective in some cases of primary intraocular large cell lymphoma. Furthermore, the Ommaya reservoir works well for intrathecal delivery of methotrexate in patients with CNS or leptomeningeal spread.
Aged↗
Atypical mycobacterial wound infection after blepharoplasty.
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Aged↗
Incidence and management of cataracts in Vogt-Koyanagi-Harada syndrome.
Of 65 consecutive patients (130 eyes) with Vogt-Koyanagi-Harada syndrome, 26 (40%) developed cataracts (49 eyes, 38%). Twenty-eight cataracts were posterior subcapsular, six nuclear, 14 combined nuclear and posterior subcapsular, and one anterior cortical. Risk factors for the development of cataracts included age (P = .003), long-standing recurrent anterior segment inflammation (P < .001), and systemic corticosteroid therapy for six months or more (P < .001). After at least three months of minimal to no intraocular inflammation, 19 eyes underwent cataract extraction, of which 11 also had posterior chamber intraocular lens implantation. Median visual acuity improved significantly from 20/400 to 20/40 (P < .01) after a median follow-up time of 13 months. Route of preoperative corticosteroids, pars plana vitrectomy, and glaucoma surgery did not markedly affect visual prognosis. If preoperative intraocular inflammation is rigorously controlled, cataract surgery can be performed safely and can result in significant visual improvement in patients with Vogt-Koyanagi-Harada syndrome.
Adult↗
Coccidioidomycosis iridocyclitis.
BACKGROUND: Coccidioidomycosis has reached epidemic proportions in the southwest region of the United States. Despite the greater numbers of cases, isolated anterior segment ocular coccidioidomycosis in the absence of systemic infection continues to be rare, although its incidence may be increasing. METHODS: Two patients without clinical evidence of systemic disease and one patient with previously treated pulmonary coccidioidomycosis had granulomatous iridocyclitis and iris nodules that were unresponsive to corticosteroid therapy. All three patients underwent iris biopsy, anterior chamber tap, and washout for histopathologic diagnosis of anterior segment disease, and all subsequently received systemic antifungal therapy. Two patients also received multiple intraocular injections of amphotericin B. RESULTS: Papanicolaou and hematoxylin-eosin-stained preparations of anterior chamber tap and biopsies of the iris in each of these patients showed fibrinopurulent or granulomatous inflammatory exudate with intact and disrupted Coccidioides spherules. Despite aggressive systemic and intraocular therapy, one patient required enucleation for a blind, painful eye. The other two patients continue to have limited visual acuity but with at least partial resolution of the intraocular lesions. CONCLUSIONS: Ocular coccidioidomycosis without clinical evidence of systemic involvement is rare. Isolated anterior segment disease is also uncommon; however, because of the current epidemic in the southwest region of the United States, ocular coccidioidomycosis should be considered in any patient who traveled through or lived in endemic areas and who has a granulomatous iridocyclitis associated with iris mass that is unresponsive to corticosteroid therapy.
Amphotericin B↗
Efficacy of lateral canthotomy and cantholysis in orbital hemorrhage.
Emergent orbital decompression in tense orbital hemorrhage with compromised ophthalmic blood flow may be achieved with lateral canthotomy, defined as incision of the lateral canthal tendon, and cantholysis, defined as canthotomy combined with disinsertion of at least the inferior crus of the lateral canthal tendon. This study was performed to determine which procedure, canthotomy, canthal tendon disinsertion, or cantholysis, produced the largest reduction in intraocular pressure after simulated orbital hemorrhage in 10 closed ruminant orbits with retrobulbar injections of normal saline. Intraocular pressure (IOP) reductions were measured after canthotomy in five orbits, after lateral canthal tendon disinsertion in five orbits, and after completion of cantholysis in all 10 orbits. Canthotomy produced a mean IOP reduction of 14.2 mm Hg. Canthal tendon disinsertion (CTD) produced a mean IOP reduction of 19.2 mm Hg. Cantholysis produced a mean IOP reduction of 30.4 mm Hg, a significantly (p < 0.05) greater reduction in IOP than that produced by canthotomy or canthal tendon disinsertion alone. Cantholysis in acute orbital hemorrhage may produce significantly greater reduction in IOP, and thus in intraorbital pressure, and allow better perfusion of orbital tissues than either lateral canthotomy or CTD.
Animals↗
Subretinal neovascular membranes in Vogt-Koyanagi-Harada syndrome.
Subretinal neovascular membranes cause late visual loss and are important determinants of final visual acuity in patients with Vogt-Koyanagi-Harada syndrome. The purpose of this study was to determine the prevalence and risk factors associated with the development of subretinal neovascular membranes in Vogt-Koyanagi-Harada syndrome. We reviewed the charts of 58 patients (116 eyes) with Vogt-Koyanagi-Harada syndrome. We separated patients into two groups, one with and one without subretinal membranes. Demographic characteristics, namely age, gender, and race, initial and final visual acuities, duration and method of treatment, anterior chamber and vitreous cell, presence of fundus pigmentary disturbances, and phase of inflammation, were evaluated for each group. Overall, ten eyes (9%) of seven patients developed the subretinal neovascular membranes. Demographic characteristics among the two groups of patients were not markedly different (P > .10). Visual outcome of patients with subretinal membranes was significantly poorer than was that of patients without these membranes (P < .001). Eyes with subretinal membranes had a significantly greater degree of anterior chamber and vitreous inflammation (P < .02), greater incidence of fundus pigmentary disturbances (P < .02), and a greater frequency of chronic recurrent phase of inflammation, marked by recurrence of predominantly anterior chamber, and occasionally posterior segment, inflammation (P < .02). The membranes were located in the peripapillary (four eyes), subfoveal (three eyes), and macular extrafoveal (three eyes) regions.
Adult↗
Progressive ocular toxoplasmosis in patients with acquired immunodeficiency syndrome.
We studied two patients, a 43-year-old Hispanic man with a one-year history of acquired immunodeficiency syndrome (AIDS) and a 34-year-old Hispanic man with newly diagnosed AIDS. Both had necrotizing retinitis that progressed to panophthalmitis and orbital cellulitis. Toxoplasmosis was not diagnosed in the first patient early in the course of the disease. The second patient had a history of toxoplasmic retinochoroiditis. Despite anti-toxoplasmosis therapy, visual acuity deteriorated to no light perception in both patients. Diagnostic biopsy of the eye wall was performed on the first patient and enucleation of the globe on the second. Toxoplasmic panophthalmitis and orbital cellulitis were diagnosed in each patient by light microscopy and confirmed by electron microscopy. When patients with AIDS develop necrotizing retinitis, toxoplasmosis must be considered in the differential diagnosis, along with cytomegalovirus retinitis, progressive outer retinal necrosis, and syphilitic retinitis. Unlike cytomegalovirus retinitis, progressive outer retinal necrosis, and syphilitic retinitis, however, toxoplasmosis can cause a progressive intraocular infection, panophthalmitis, and orbital cellulitis in patients with AIDS.
AIDS-Related Opportunistic Infections↗
Endogenous Aspergillus endophthalmitis in an immunocompetent individual.
We present an unusual case of Aspergillus fumigatus endogenous endophthalmitis in a 27 year old Hispanic male with no history of ocular trauma, surgery, hematologic malignancy, compromised immune system, or intravenous drug use. The patient presented with a two-day history of pain, redness, and visual acuity of bare count fingers in his right eye. He was originally suspected of having toxoplasmic retinochoroiditis, but clinically worsened on systemic anti-toxoplasma medication and corticosteroids. He subsequently underwent pars plana vitrectomy and treatment with intravenous and intravitreal amphotericin B. Aspergillus fumigatus was isolated and identified in the vitreous aspirate. With aggressive medical and surgical management, he eventually regained visual acuity of 20/30 in his right eye. This case illustrates the occurrence of endogenous Aspergillus endophthalmitis in a patient with no history of intravenous drug use, ocular trauma, or compromised immune system, and successful outcome with combined medical and surgical management.
Adult↗
Spontaneous orbital subperiosteal hematomas in patients with liver disease.
Spontaneous orbital subperiosteal hematomas are rare entities. They are often associated with systemic coagulopathies. We present two cases of spontaneous orbital subperiosteal hematomas in patients with systemic coagulopathies resulting from liver disease. One patient was diagnosed with hepatitis B and had spontaneous resolution of the hematoma. Another patient had alcoholic cirrhosis and required an orbitotomy for drainage of a hematoma for compressive optic neuropathy. With the rising incidence of hepatitis B and the prevalence of alcoholic liver disease, it is important to include liver disease in the systemic evaluation of patients with spontaneous orbital subperiosteal hematomas.
Adult↗