RESUMEN
We identified 10 patients who developed cytomegalovirus (CMV) retinitis after HSCT during a 14-year period. The median day of diagnosis of CMV retinitis after transplantation was day 251 (range, days 106--365). CMV retinitis was associated with CMV serostatus of donor or recipient (P=0.01), CMV reactivation before day 100 (P=0.007), delayed lymphocyte engraftment (P<0.05), and chronic graft versus host disease (GVHD; P<0.001). In allogeneic recipients of HSCT who were alive at day 100 after transplantation and had chronic clinical extensive GVHD, the incidence of GVHD was 1.4% (8 of 577). Five of 10 patients had other manifestation of CMV disease before retinitis occurred (4 with gastrointestinal disease and 1 with interstitial pneumonia; median time, 70 days before onset of CMV retinitis; range, 58--279 days), and 4 others had CMV excretion. CMV retinitis was bilateral in 4 patients; 9 of 10 patients had ocular symptoms (i.e., decreased vision and floaters). Six of 7 patients responded well to ganciclovir or foscarnet systemic treatment, 1 improved only after switching to cidofovir, and 1 patient who received a transplant in 1983 did not respond to acyclovir treatment. In conclusion, CMV retinitis is an uncommon late complication after HSCT that occurs mainly in seropositive allograft recipients with previous CMV reactivation and chronic GVHD, and with delayed engraftment of lymphocytes.
Asunto(s)
Retinitis por Citomegalovirus/virología , Citomegalovirus , Trasplante de Células Madre Hematopoyéticas , Organofosfonatos , Complicaciones Posoperatorias/virología , Adulto , Antivirales/uso terapéutico , Enfermedad Crónica , Cidofovir , Citomegalovirus/genética , Retinitis por Citomegalovirus/tratamiento farmacológico , Retinitis por Citomegalovirus/epidemiología , Citosina/análogos & derivados , Citosina/uso terapéutico , Femenino , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Compuestos Organofosforados/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Factores de Riesgo , Resultado del Tratamiento , Activación ViralAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/uso terapéutico , Retinitis por Citomegalovirus/tratamiento farmacológico , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Inhibidores de la Transcriptasa Inversa/farmacología , Terapia Recuperativa , Retinitis por Citomegalovirus/complicaciones , Progresión de la Enfermedad , HumanosRESUMEN
The systemic complications of homozygous sickle cell disease (SS) are more severe than in sickle cell haemoglobin C (SC) disease, and yet visual loss due to proliferative retinopathy is more common in the latter. This anomaly is unexplained. It is believed that proliferative disease occurs in response to closure of the peripheral retinal vasculature, yet a systematic longitudinal survey of the peripheral retinal vascular bed has not been undertaken. In the Jamaica Sickle Cohort study all subjects are scheduled to receive annual ocular examination and fluorescein angiography. The results have now been analysed in subjects with SS and SC disease using a new classification system based on a comparison of the peripheral retinal vascular bed with that recorded in the cohort with normal haemoglobin (AA) genotype. The vascular patterns could be classified as qualitatively normal (type I) or abnormal (type II). An abnormal vascular pattern was identified more commonly with age, in a significantly larger proportion of subjects with SC than SS disease, and was associated with the development of proliferative disease. In order to establish the dynamics of change, the angiograms were analysed in the 18 subjects (24 eyes) who developed proliferative disease. It is shown that a qualitatively normal vascular pattern may be retained despite loss of capillary bed and posterior displacement of the vascular border. A border which is qualitatively abnormal does not revert to normal, and once abnormal, continuous evolution may occur before development of proliferative lesions. The peripheral border of the retinal vasculature was too peripheral to photographed in 13 of the 24 eyes before it becoming qualitatively abnormal. It is concluded that a normal border, if posterior, results from gradual modification of the capillary bed and indicates low risk of proliferative disease. A qualitatively abnormal vascular border occurs as a radical alteration of retinal perfusion in subjects in whom little modification of the vascular bed occurred before the event, and signals risk of proliferative disease. This classification system is useful in identifying the likelihood of threat to vision in young Jamaicans with sickle cell disease, and the higher frequency of proliferative retinopathy in SC can be explained by the higher prevalence of a qualitatively abnormal peripheral retinal vasculature.
Asunto(s)
Anemia de Células Falciformes/patología , Enfermedad de la Hemoglobina SC/patología , Vasos Retinianos/patología , Adolescente , Capilares/patología , Niño , Preescolar , Estudios de Cohortes , Angiografía con Fluoresceína , Humanos , Retina/patología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
A prospective study of the peripheral retinal vasculature in a Jamaican cohort of subjects with sickle cell disease has been in progress over a period of 12 years using fluorescein angiography. Various vascular patterns were identified but their significance was unclear since no comparable records were available in subjects of a similar age with normal (AA) haemoglobin genotype. Fluorescein retinal angioscopy and angiography have been performed in 76 haemoglobin AA controls participating in the cohort study. The peripheral retinal capillary bed could be seen and photographed in a limited portion of the temporal peripheral fundus in a majority of this group, and there was considerable variation in the vascular pattern which could be characterised. These observations allow deviations from normal to be identified in the retinal vasculature in subjects with sickle cell disease.
Asunto(s)
Enfermedades de la Retina/diagnóstico , Vasos Retinianos/anatomía & histología , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Angioscopía , Anastomosis Arteriovenosa/anatomía & histología , Capilares/anatomía & histología , Estudios de Cohortes , Femenino , Angiografía con Fluoresceína , Humanos , Jamaica , Masculino , Estudios Prospectivos , Enfermedades de la Retina/etiologíaRESUMEN
In patients with AIDS, the most important ocular opportunistic infection, CMV retinitis, can now be treated effectively with virostatic agents. Associated retinal detachment is encountered frequently, and its management has become increasingly significant to quality of life as improvements in medical care have helped to preserve vision and extend life expectancy. Although retinal detachment in these eyes is typically rhegmatogenous, the pathophysiology is distinctive due to the association with CMV retinitis which, even in remission, is characterised by atrophic changes at all levels of affected retina and alterations of the vitreous. Despite initially successful surgical reattachment, multiple, small, often posterior holes may develop because of progressive CMV infection. For these reasons, vitrectomy and silicone oil injection with scleral buckling may currently provide the best overall means of maintaining retinal reattachment and restoring visual function. Nevertheless, management must be individualised in each case, with the realisation that progressive visual loss frequently ensues from retinitis progression.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por Citomegalovirus/complicaciones , Desprendimiento de Retina/cirugía , Retinitis/complicaciones , Infecciones por Citomegalovirus/patología , Humanos , Retina/patología , Retina/cirugía , Desprendimiento de Retina/etiología , Retinitis/patologíaRESUMEN
The effect of scatter photocoagulation on the perfusion of iatrogenic choriovitreal neovascularisation (CVN) has been assessed by a randomised trial in 35 CVN lesions in 18 eyes with proliferative sickle retinopathy. No difference in size or vascularity of CVN lesions was apparent between the nine treated and nine control eyes over a median follow-up of 42 months. Scatter photocoagulation by the stated protocol was not effective in the treatment of CVN.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Coroides/irrigación sanguínea , Fotocoagulación , Neovascularización Patológica/cirugía , Cuerpo Vítreo/irrigación sanguínea , Adulto , Humanos , Fotocoagulación/efectos adversos , Persona de Mediana Edad , Neovascularización Patológica/etiologíaRESUMEN
Members of the herpesvirus family, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV), have been recognized as causal agents of chorioretinal inflammatory diseases. We investigated the use of the polymerase chain reaction for the detection of CMV, HSV, and EBV genomes in aqueous, subretinal fluid, and vitreous specimens in patients with clinically diagnosed CMV retinitis. Cytomegalovirus but not HSV or EBV genomic sequences were detected in all of these clinical specimens. We also investigated 18 normal aqueous and eight normal vitreous specimens obtained from patients undergoing cataract or vitrectomy surgery. Cytomegalovirus, HSV, and EBV DNA were not detected in any of the normal aqueous specimens. There was one weakly positive CMV normal vitreous, but none was HSV or EBV positive by the polymerase chain reaction. These results indicate that the polymerase chain reaction may be useful as a rapid and sensitive diagnostic technique to aid in the confirmation of clinical observations.
Asunto(s)
Humor Acuoso/microbiología , ADN Viral/análisis , Herpesviridae/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Cuerpo Vítreo/microbiología , Síndrome de Inmunodeficiencia Adquirida/microbiología , Anticuerpos Antivirales/sangre , Autorradiografía , Citomegalovirus/genética , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/microbiología , Herpesviridae/genética , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Reacción en Cadena de la Polimerasa/métodos , Retinitis/microbiología , Simplexvirus/genética , Simplexvirus/aislamiento & purificaciónRESUMEN
To identify the magnitude of risk of fellow-eye visual loss, we reviewed the records of 43 patients with unilateral central visual loss caused by a tear of detached retinal pigment epithelium seen in our institution over a period of one to 13 years. Loss of vision because of complications of age-related macular disease occurred in 16 of 43 patients (37%) in the first year, seven of 23 patients (30%) in the second year, and eight of 16 patients (50%) in the third year. An additional five patients lost visual acuity between the third and eighth years of follow-up. The cumulative risk of loss of visual acuity was 37% in one year, 59% in two years, and 80% in three years. Visual loss occurred in 29 of the 36 eyes as a result of a complication of retinal pigment epithelial detachment. The magnitude of risk to the fellow eye was greater than has been documented in unselected age-related macular degeneration.
Asunto(s)
Epitelio Pigmentado Ocular/patología , Perforaciones de la Retina/complicaciones , Trastornos de la Visión/epidemiología , Anciano , Envejecimiento , Femenino , Estudios de Seguimiento , Humanos , Degeneración Macular/complicaciones , Masculino , Pronóstico , Factores de Riesgo , Factores de Tiempo , Trastornos de la Visión/complicaciones , Agudeza VisualRESUMEN
Eyes with tears of detached retinal pigment epithelium have been studied for up to 10 years following the acute event. In a retrospective study it has been determined that such a lesion in one eye implies a high risk of a similar event occurring in the fellow eye. Patients with loss of vision in their second eye as a result of a pigment epithelial tear were also studied; in 10 of 22 patients a similar lesion could be identified in the first eye. These observations suggest that these patients have specific changes at the level of Bruch's membrane which predispose to this particular manifestation of age related macular disease.
Asunto(s)
Epitelio Pigmentado Ocular/patología , Perforaciones de la Retina/patología , Factores de Edad , Anciano , Anciano de 80 o más Años , Ceguera/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perforaciones de la Retina/complicaciones , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We compared drusen in the fellow eye of patients with unilateral retinal pigment epithelial tears with those in an age- and sex-matched group of patients with unilateral primary neovascular disciform lesions. In the fellow eye of patients with tears, drusen were more confluent and manifested less fluorescence on angiography than in the comparison group. These observations are in accord with the concept that Bruch's membrane represents a significant barrier to fluid flow, and that fluid beneath detached pigment epithelium is derived in part or wholely from the pigment epithelium.
Asunto(s)
Epitelio Pigmentado Ocular , Perforaciones de la Retina/etiología , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Humanos , Mácula Lútea/irrigación sanguínea , Degeneración Macular/complicaciones , Degeneración Macular/patología , Masculino , Persona de Mediana Edad , Neovascularización Patológica/patología , Perforaciones de la Retina/complicaciones , Perforaciones de la Retina/patología , Rotura EspontáneaAsunto(s)
Mácula Lútea , Desprendimiento de Retina/diagnóstico , Enfermedad Aguda , Adulto , Exudados y Transudados , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Mácula Lútea/patología , Masculino , Prednisona/uso terapéutico , Desprendimiento de Retina/tratamiento farmacológico , Agudeza VisualRESUMEN
Sixty-three eyes (in 59 patients) with tears of detached retinal pigment epithelium have been studied for a period of up to 10 years after the acute event. In the majority of cases a plaque of fibrous tissue was laid down gradually in the bed of the tear. In a few eyes the inner surface of Bruch's membrane appeared to remain relatively unaltered for up to 2 years, and in four eyes it was recovered with pigmented tissue resembling normal retinal pigment epithelium. These and other changes progressively obscured the distinctive feature of the original lesion; the nature of the original lesion was evident at 6 months in all cases, by 1 year it was recognisable in 94 per cent, by 2 years in 77 per cent and by 6 years in none. Choroidal neovascularisation was detected or suspected in one third of cases in the acute stages and developed in others weeks to months after the acute event. Alteration of the morphology occurred more quickly, and there was greater scarring, in those with new vessels or significant blood in the subretinal space, when compared with those without such features. Visual acuity was surprisingly good in many patients immediately after the tear. However, loss of vision accompanied the reactive tissue remodelling, and no case had long term retention of good visual acuity.
Asunto(s)
Epitelio Pigmentado Ocular/patología , Desprendimiento de Retina/complicaciones , Perforaciones de la Retina/patología , Anciano , Anciano de 80 o más Años , Coroides/irrigación sanguínea , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Neovascularización Patológica/patología , Hemorragia Retiniana/complicaciones , Perforaciones de la Retina/complicaciones , Factores de Tiempo , Agudeza VisualRESUMEN
Patients with acute and chronic central serous retinopathy (CSR) were studied by psychophysical and photochemical means to establish the extent of visual depression and to investigate the basis of rod dysfunction in this disorder. In acute disease with serous detachment of the retina, the loss of sensitivity attains 3 log units and parallels the height of retinal elevation as does its recovery with resolution of the episode. Immediately after resolution, there is a residual 0.5 log unit threshold elevation. In chronic disease, marked loss of function exists over areas of abnormal retinal pigment epithelium in the absence of clinically detectable serous detachment. Although rhodopsin levels are low in both acute and chronic CSR, this relative lack of visual pigment does not totally account for the functional deficits in either situation.
Asunto(s)
Retina/fisiopatología , Enfermedades de la Retina/fisiopatología , Angiografía con Fluoresceína , Humanos , Células Fotorreceptoras/fisiopatología , Desprendimiento de Retina/etiología , Retinitis/complicaciones , Rodopsina/análisis , Percepción VisualRESUMEN
Age-related Macular Degeneration (AMD) is responsible for the majority of registered blindness in the elderly. Laser photocoagulation can be offered as a treatment of proven value to only a proportion of patients with neovascular AMD. Clinically, our expectations must be tempered by the high incidence of recurrent subretinal vessels, the anatomic limitations of treatable lesions and the large number of ageing eyes for which there is no place for laser. In addition to improvements in education, referral habits and the application of laser therapy which may have an impact upon visual loss due to AMD, there are promising directions to be explored in alternative modes of treatment and prevention.
Asunto(s)
Envejecimiento , Degeneración Macular/cirugía , Anciano , Humanos , Fotocoagulación , Neovascularización Patológica , Epitelio Pigmentado Ocular/cirugía , Complicaciones Posoperatorias/prevención & control , Desprendimiento de Retina/cirugía , Agudeza VisualRESUMEN
Patients with long bone fractures are at risk for the fat embolism syndrome (FES). Although an estimated 50% of patients with overt FES have retinal abnormalities, the overall incidence of fundus lesions in patients with long bone fractures has not been studied. We examined 100 consecutive patients who had suffered long bone or pelvic fractures in the absence of head, abdominal, or thoracic injury, and who had no other diseases associated with retinopathy. Only one patient had visual symptoms. Cotton-wool spots and retinal hemorrhages were observed in four patients, none of whom were suspected of FES prior to our examination. Subclinical FES may be found by ophthalmoscopy in patients with long bone fractures.
Asunto(s)
Embolia Grasa/etiología , Fracturas Óseas/complicaciones , Enfermedades de la Retina/etiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Persona de Mediana EdadRESUMEN
A spontaneous corneal perforation followed by granulomatous uveitis occurred in a 10-month-old female infant with bilateral anterior segment anomalies. The histopathologic findings in the enucleated right eye and the 30-year course of intraocular inflammation in her left eye are consistent with sympathetic ophthalmia. This case illustrates that sympathetic ophthalmia can be overlooked for years unless the diagnosis is considered and periodic anterior segment biomicroscopy and indirect ophthalmoscopy are performed in patients who have had perforating ocular injuries. A lensectomy-vitrectomy procedure was successful in restoring ambulatory vision in this patient.
Asunto(s)
Oftalmía Simpática/diagnóstico , Uveítis/diagnóstico , Adolescente , Adulto , Niño , Preescolar , Enfermedades de la Córnea/complicaciones , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Lactante , Cristalino/cirugía , Oftalmía Simpática/cirugía , Rotura Espontánea , Factores de Tiempo , Úvea/patología , Cuerpo Vítreo/cirugíaRESUMEN
Tricalcium phosphate ceramic, a synthetic bone substitute, was inserted into defects created in the inferior orbital rims of 18 rabbits. The animals were killed after three, eight, 24, and 40 weeks. Early sections demonstrated encapsulation with fibrous ingrowth. After eight weeks, osteoid formation was evident with partial resorption of the porous mineral implant. After 24 and 40 weeks, there was progressive replacement of tricalcium phosphate ceramic with trabecular bone, without signs of infection, migration, or rejection.
Asunto(s)
Fosfatos de Calcio , Órbita/cirugía , Prótesis e Implantes , Animales , Osteogénesis , ConejosRESUMEN
Studies were performed in Munich-Wistar rats to determine whether changes in papillary plasma flow might be responsible for the concentrating defect which occurs after exposure of the extrarenal papilla. Papillary plasma flow was measured by (125)I-albumin accumulation. Initial studies in hydropenic animals revealed that papillary plasma flow was 40% higher in the kidney with the exposured papilla, 41 vs. 29 ml/min per 100 g of papilla (P < 0.001). This increase in papillary plasma flow was detectable 15 or 45 min after removing the ureter. Because it was unclear whether the rise in papillary plasma flow was a cause or the result of the fall in urine osmolality, similar studies were performed in animals undergoing a water diuresis. In this setting, papillary plasma flow still increased on the exposed side compared to the control side, 81 vs. 60 ml/min per 100 g, despite similarly low urine osmolalities of 155 and 174 mosmol/kg, respectively. This finding is compatible with the possibility that papillary exposure per se causes an increase in papillary plasma flow and that this hemodynamic alteration may lead to a reduction in urinary osmolality secondary to washout of the medullary interstitium. A final group of hydropenic rats was given either indomethacin or meclofenamate before removing the ureter. In these studies, there was no difference in either the papillary plasma flow or the urine osmolality between control and exposed kidneys. It is therefore suggested that opening the ureter induces an increase in papillary plasma flow by some mechanism which may involve an alteration in prostaglandin synthesis.