RESUMEN
We report the frequency and type of infectious ocular complications following orthotopic liver transplantation (OLT) and review diagnostic and therapeutic strategies. During the period September 1988 through November 1994, 684 patients underwent OLT at Mount Sinai Hospital (New York). Nine orthotopic liver transplant patients (1.3%) developed ocular infections: Candida albicans endophthalmitis (2), Aspergillus fumigatus endophthalmitis (1), cytomegalovirus retinitis (4), herpes simplex virus keratitis (1), and varicella-zoster virus panophthalmitis (1). The mean time from OLT to ocular symptoms was 42 days for patients with fungal infections and 128 days for patients with viral infections. Blurred vision was the commonest symptom (five of nine cases). The mean duration of follow-up was 2 years (range, 33 days to 5 years). Permanent loss of vision occurred in three patients, five had improvement in visual acuity, and one died of disseminated aspergillosis 33 days after OLT. Infectious ocular complications following OLT may occur as isolated events or with disseminated disease. Fungal infections occur earlier (mean, 42 days after OLT) than viral infections (mean, 4 months after OLT). The clinical presentation may be atypical; aggressive vitreoretinal procedures and serial examinations may be required to establish the diagnosis. Cytomegalovirus retinitis in orthotopic liver transplant patients may not require life-long maintenance therapy with antiviral agents.
Asunto(s)
Infecciones Fúngicas del Ojo/etiología , Infecciones Virales del Ojo/etiología , Trasplante de Hígado/efectos adversos , Adulto , Preescolar , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retinitis/diagnóstico , Retinitis/etiología , Retinitis/terapiaRESUMEN
Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.
Asunto(s)
Potenciales Evocados Visuales , Mácula Lútea , Orientación/fisiología , Enfermedades de la Retina/fisiopatología , Adulto , Anciano , Humanos , Persona de Mediana Edad , Estimulación Luminosa , Tiempo de ReacciónRESUMEN
Two larvae of Taenia solium (eg, Cysticercus cellulosae) were identified in the posterior vitreous attached to the optic nervehead of a 13-year-old Guatemalan girl. Preoperative evaluation showed the larvae to be viable. The vitreous showed a mild cellular reaction. The larvae were dissected off the optic nervehead and removed via a pars plana approach, without incident. To our knowledge, this is the first case report of cysticerci attached to the optic nervehead that were removed successfully by the pars plana approach. The patient was treated with a very short preoperative and postoperative course of corticosteroids. No inflammatory flare-ups or recurrence of the cysticercosis were found during the one-year follow-up period.