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At least 1,081 records · Page 60Linked to original sources
PubMed2005

Bilateral endogenous Scedosporium prolificans endophthalmitis after lung transplantation.

PURPOSE: To report a case of bilateral endogenous fungal endophthalmitis resulting from disseminated Scedosporium prolificans. DESIGN: Observational case report. METHODS: A 56-year-old woman with cystic fibrosis status post dual lung transplantation on chronic immunosuppressive therapy presented with acute graft rejection. Cultures of bronchial brushings revealed S. prolificans. Three weeks after admission, the patient noted increased blurriness and a central scotoma in her right eye. Dilated fundus examination revealed profound vitritis in the right eye with hemorrhagic retinitis involving the macula. A peripheral, yellow choroidal infiltrate with overlying retinitis and localized vitritis was present in the left eye. RESULTS: Intravitreal antibiotics were initiated, and vitreous cultures revealed S. prolificans. The patient ultimately succumbed to her disseminated disease. Pathologic examination of the eyes confirmed bilateral endogenous fungal endophthalmitis. CONCLUSION: S. prolificans is an opportunistic infection resistant to standard antifungal therapy that can result in endogenous endophthalmitis in immunocompromised individuals.

Anti-Bacterial Agents↗
PubMed2006

Histopathologic findings after radial optic neurotomy in central retinal vein occlusion.

PURPOSE: Radial optic neurotomy (RON) in central retinal vein occlusion (CRVO) is a novel strategy that is aimed at relief of mechanical pressure on the central retinal vein. We report on histopathologic findings in a human eye 18 weeks after RON. DESIGN: Interventional case report. METHODS: Eighteen weeks after RON for ischemic CRVO, an eye was enucleated because of neovascular glaucoma and examined histologically. RESULTS: Histopathologic evidence demonstrated displaced fragments of Bruch's membrane surrounded by retinal tissue at the nasal side of the papilla. A discrete scar was noted at this site that reached the cribriform plate without involving the adjacent sclera or the retinal vessels. The optic nerve showed advanced atrophy with a small temporal sector of viable nerve fibers. CONCLUSIONS: Histopathologic findings after RON do not provide evidence for the postulated mechanism of action. It appears prudent to further evaluate this technique before its general implementation in the management of CRVO.

Aged↗
PubMedDate not supplied

Cogan's syndrome: a cause of progressive hearing deafness.

In 1934 Morgan and Baumgartner first described a nonsyphilitic interstitial keratitis (IK) associated with vestibuloauditory dysfunction (Morgan RF, Baumgartner CF, Menier's disease complicated by recurrent interstitial keratitis. Excellent result following cervial ganglionectomy. West J Surg 1934;42:628). Cogan was the first to describe this syndrome as a clinical entity with the report of 5 additional cases in 1945 (Cogan DA: Syndrome of nonsyphilitic interstitial keratitis and vestibuloauditory symptoms. Arch Ophthalmol 1945;33:144-9). Since that time, more than 100 cases of Cogan's syndrome (CS) have been in the literature. Cogan's syndrome is a rare clinical disease, which primarily affects young adults; however, published reports range from 2.5 to 60 years for age of onset (Kundell Sp, HD Ochs: Cogan's syndrome in childhood. J Pediatr 1980;97:96-8). This disease primarily affects whites and is believed not to be hereditary. Typical CS is characterized by IK and vestibuloauditory dysfunction. The IK usually occurs with sudden onset and is characterized by photophobia, lacrimation, and eye pain. The vestibuloauditory dysfunction is usually bilateral, presenting with tinnitus, sensorineural hearing loss, and acute episodes of vertigo. Atypical CS presents with significant inflammatory eye disease (ie, scleritis, episcleritis, retinal artery occlusion, choroiditis, retinal hemorrhages, papilloedema, exophthalmos, or tenonitis) with or without IK (Laryngoscope 1960;70:447-9). In this report, we describe a typical case of CS, in which the hearing loss was unresponsive to corticosteroid therapy.

Adult↗
PubMed2004

[Management of acute visual loss in children].

Acute or rapidly progressive visual loss in children needs urgent attention and treatment. It may be unilateral orbilateral. Etiology depends upon the involved areas: eye ball, optic nerve, retro-chiasmatic pathways. Psychogenic origin is quite common in school-age children, however, it has to be considered last. Unilateral visual loss may be overlooked. Acute total transitory visual loss may be due to epilepsy or to migraine. Rapidly progressive visual loss may be due to retinal disease, optic neuritis or cortical blindness. Management of visual loss depends on clinical features, associated symptoms, and aspect of the optic disc. It needs collaboration between ophthalmologist,pediatrician and neuropediatrician. Retinal hemorrhages first call to mind a traumatic origin. Swelling of the optic disc may be due to increased intracranial pressure or due to optic neuritis. When the optic disc is normal it is necessary to rule out organic diseases before establishing the diagnosis of a psychogenic vision disturbance. In emergency, brain neuroimaging is the best way to diagnose intracranial mass and visualize optic pathways.

Acute Disease↗
PubMed2005

Perpetrator accounts in infant abusive head trauma brought about by a shaking event.

OBJECTIVE: To analyze perpetrator and medical evidence collected during investigations of infant abusive head trauma (IAHT), with a view to (a) identifying cases where injuries were induced by shaking in the absence of any impact and (b) documenting the response of infant victims to a violent shaking event. METHOD: A retrospective study was undertaken of IAHT cases investigated by the Queensland Police Service over a 10-year period. Cases of head trauma involving subdural and/or subarachnoid hematoma and retinal hemorrhages, in the absence of any evidence of impact, were defined as shaking-induced. Perpetrator statements were then examined for further evidence to support the shaking hypothesis and for descriptions of the victim's immediate response to a shaking event. RESULTS: From a total of 52 serious IAHT cases, 13 (25%) were found to have no medical or observer evidence of impact. In 5 of those 13 cases, there was a statement by the perpetrator to the effect that the victim was subjected to a shaking event. In several cases both with and without evidence of associated impact, perpetrator accounts described an immediate neurological response on the part of the victim. CONCLUSION: The study confirms that IAHT resulting in death or serious neurological impairment can be induced by shaking alone. In cases where the infant's medical condition was adequately described, the symptoms of head injury presented immediately.

Child Abuse↗
PubMed2005

Case series of angle-closure glaucoma after laser treatment for retinopathy of prematurity.

PURPOSE: Laser photocoagulation is the current treatment standard for severe retinopathy of prematurity (ROP). Uncommon, but well recognized complications include cataract, and vitreous and retinal hemorrhage. Angle-closure glaucoma after laser photocoagulation for ROP is rare. The purpose of this study was to identify additional cases of angle-closure glaucoma following laser treatment for ROP. METHODS: Five eyes of four patients with angle-closure glaucoma following laser treatment for ROP were identified by three ophthalmologists at separate institutions between 1997 and 2001. Demographic and clinical data were obtained from medical records. Clinical and surgical findings associated with the diagnosis and management of angle-closure glaucoma following ROP laser were evaluated. RESULTS: The following data were collected (mean (range)): gestational age, 26.8 (24 to 29) weeks; birth weight, 833 (570 to 1062) g; age at laser treatment for ROP, 35 (33 to 37) weeks; number of laser burns, 1598 (930 to 2400); and time to diagnosis of angle-closure glaucoma, 3.6 (2 to 5) weeks. Three of five eyes had objective data for intraocular pressure (IOP) and corneal diameter with mean IOP 41 mm Hg (35 to 44) and mean corneal diameter 11.1 mm (10.25 to 11.5). Initial treatment included topical and systemic medications. Three eyes required surgical intervention. Angle-closure resolved in all cases with normalization of IOP. Follow-up (5 months to 3.6 years) showed that affected eyes tended to be more myopic than unaffected fellow eyes (mean spherical equivalent -6.5 vs -4.7 diopters). CONCLUSIONS: Angle-closure glaucoma can develop following laser treatment for severe ROP. Medical, and frequently surgical, intervention provides effective management.

Female↗
PubMed2005

Bilateral acute retinal necrosis in a 12-year-old girl.

Acute retinal necrosis (ARN) is a severe ocular syndrome consisting of a moderate-to-severe anterior uveitis, vasculitis, and vaso-occlusive retinal necrosis. It can occur in healthy individuals at any age, but reports of this condition in children are rare.

Acyclovir↗
PubMed2005

Anterior vitreous tapping to manage positive vitreous pressure during triple procedures.

PURPOSE: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK) combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. DESIGN: Nonrandomized prospective noncomparative interventional case series. PARTICIPANTS: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. METHODS: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tapping was performed with a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. MAIN OUTCOME MEASURES: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. RESULTS: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6+/-2.6 months (range, 6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8% had a postoperative BCVA of > or =20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. CONCLUSIONS: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.

Adult↗
PubMed2002

Loss of vision caused by expansion of intraocular perfluoropropane (C(3)F(8)) gas during nitrous oxide anesthesia.

PURPOSE: To report visual loss associated with nitrous oxide anesthesia in patients with intraocular perfluoropropane (C(3)F(8)) gas. DESIGN: Observational case series. METHODS: Three patients are described who lost vision in the eye with intraocular gas after subsequent nitrous oxide general anesthesia. RESULTS: Three patients, aged 75, 80, and 73 years, with intraocular C(3)F(8) gas in three eyes underwent nitrous oxide general anesthesia in three different medical centers for conditions unrelated to their ophthalmic surgery, ranging from 10 days to 1 month after their vitreoretinal procedure. All three patients suffered visual loss due to presumed central retinal artery occlusion caused by expansion of the intraocular gas by nitrous oxide during general anesthesia. In two patients, there was no recovery of light perception. In one patient, there was moderate recovery of vision. CONCLUSIONS: Identification of patients with intraocular gas is critical when planning nitrous oxide anesthesia. This may be achieved by the use of a simple intraocular gas identification bracelet issued to patients at the time of their vitreoretinal procedure.

Aged↗
PubMed1997

Primary antiphospholipid antibody syndrome and retinal occlusive vasculopathy.

PURPOSE: To report a 31-year-old healthy patient with retinal venous occlusion in his left eye attributable to primary antiphospholipid antibody syndrome. METHODS: The patient was examined clinically. Multiple serologic and clinical investigations were performed to determine the causative disease. He was closely followed up for more than 3 years. RESULTS: The presence of lupus anticoagulant in our patient was indicated by a kaolin clotting time index of 27 (normal, <17) and confirmed by the demonstration of IgG antibodies against phospholipids. After long-term oral anticoagulant treatment for 2 years, lupus anticoagulant levels returned to normal, and therapy was stopped. No further thrombotic event occurred during follow-up. CONCLUSIONS: In retinal vascular occlusions of unexplained origin, antiphospholipid antibodies may play an important role in the pathogenesis. Detecting these antibodies in the serum of patients with retinal vascular occlusion helps determine the appropriate treatment with long-term oral anticoagulants.

Adult↗
PubMed1993

Assault-related penetrating ocular injury.

We performed a retrospective study of 42 patients with penetrating ocular injury resulting from assault over a five-year period (1986 through 1991). Thirty-six patients were male (86%) and six were female, with a mean age of 29 years. Twenty-nine of 42 patients (70%) had consumed alcohol or used illegal drugs before their injury. Fists were the leading cause of injury (ten patients), followed by broken glass (nine patients). At least six months of follow-up was obtained on 40 patients (95%), with a mean follow-up of ten months. Ten (25%) patients had good visual outcome with final visual acuity of 20/40 or better. Twenty-five patients (63%) had final visual acuity of less than 5/200 at final follow-up. In this group with poor visual outcome, 12 patients (48%) underwent enucleation or evisceration (five primarily) because of extensive ocular damage. Five of 42 patients (12%) had visual acuity of no light perception, and eight (20%) had visual acuity ranging from light perception to counting fingers. The remaining five patients (12%) had final visual acuities between 20/100 and 5/200. Factors predictive of poor visual outcome were as follows: (1) initial visual acuity of light perception or worse; (2) injury by a blunt object; (3) posterior scleral lacerations (> 15 mm in length); and (4) presence of vitreous hemorrhage, retinal detachment, and prolapsed uvea. Penetrating ocular injury with posterior segment involvement caused by assaultive injury results in guarded visual outcome in most patients. Prevention of such injuries remains difficult.

Adolescent↗
PubMed1983

Retinal damage from a Q-switched YAG laser.

A 42-year-old woman with sickle cell anemia and proliferative retinopathy underwent neodymium-YAG laser therapy for a taut posterior hyaloid membrane causing peripapillary and peripheral traction detachment of the retina. Vitrectomy was not done because the patient required anticoagulation. A Q-switched YAG laser was capable of cutting holes in the taut membrane, but treatment 2 to 3 mm from the retina resulted in microperforation of a retinal vein and focal areas of damage to the retinal pigment epithelium. The damage to the retinal pigment epithelium was not immediately apparent, and ophthalmoscopically visible lesions were seen only when the patient was reexamined 48 hours later.

Adult↗
PubMedDate not supplied

Choroidal vascular lesions identified by ICG angiography in a case of familial amyloidotic polyneuropathy.

BACKGROUND: To describe a patient with familial amyloidotic polyneuropathy (FAP) whose choroidal vascular lesions were demonstrated dynamically with the use of indocyanine green (ICG) angiography. CASE: A 59-year-old man complained of blurred vision due to vitreal amyloidosis in both eyes. Fundus examination after pars plana vitrectomy showed multiple retinal hemorrhages. OBSERVATIONS: ICG angiography performed after vitrectomy clearly delineated multiple sites of hyperfluorescence indicating tissue staining alongside the major choroidal veins in the lower fundus of his left eye. ICG hyperfluorescence was more evident in the late angiographic phase. Fundus examination and fluorescein angiography revealed no abnormal findings at the corresponding sites of ICG dye leakage. CONCLUSIONS: Choroidal vascular lesions in eyes with FAP were demonstrated in vivo using ICG angiography for the first time. ICG angiography may be very beneficial to evaluate occult choroidal involvement in patients with FAP.

Amyloid Neuropathies, Familial↗
PubMedDate not supplied

Central retinal vein occlusion during remission of ulcerative colitis.

BACKGROUND: Retinal vascular disease is a rare complication of ulcerative colitis. CASE: We report a patient who developed unilateral nonischemic central retinal vein occlusion (CRVO) (papillophlebitis) without any other retinal vascular disease during remission of ulcerative colitis. OBSERVATIONS: The best-corrected visual acuities were 1.5 OD and 0.7 OS. Dilated and tortuous retinal veins and retinal bleeding were seen in the left eye. Macular edema and leakage from the papilla and the retinal veins of the left eye were evident on fluorescein angiography. After increased dosage of systemic prednisolone was prescribed, the retinal vascular changes resulting from CRVO (papillophlebitis) in the left eye gradually abated. CONCLUSIONS: Retinal vascular diseases should be monitored during both remission and activation of intestinal symptoms of ulcerative colitis.

Adult↗
PubMed1986

Magnetic resonance imaging of intracranial injuries from child abuse.

Magnetic resonance imaging (MRI) and computed tomography (CT) were compared in four children who had evidence of intracranial injury caused by shaking. All children had intracranial bleeding, neurologic impairment, and history or physical examination findings suggestive of child abuse. Three had bilateral retinal hemorrhages, and three had visual impairment. MRI revealed bilateral subdural hematomas in all four children, but CT showed this in only one. Skull fractures in one patient were visualized by CT alone. MRI alone demonstrated posterior fossa bleeding in one patient and intraparenchymal bleeding in another; an additional patient in whom CT showed relatively diffuse atrophy also had defined areas of focal atrophy apparent on MRI. Subarachnoid hemorrhages were equally well detected using CT or MRI. Overall, MRI was superior to CT for detection of intracranial injury caused by shaking, and may help to document milder instances of this form of child abuse.

Brain Injuries↗