RESUMEN
PURPOSE: To report the ocular manifestations of acute serologically confirmed murine typhus. METHODS: A retrospective analysis of the clinical history, photography and fluorescein angiography of two patients with acute murine typhus with ocular involvement was conducted. RESULTS: A 38 year old male and a 49 year old female were included in the study. Both complained of fever, headache, rash, night sweats and pulmonary symptoms. They had noted the recent onset of diminished visual acuity and floaters. Examination of the posterior pole revealed mild optic nerve head edema (in one patient), intraretinal hemorrhages and small localized areas of retinal whitening. The history confirmed that both patients had been exposed to fleas and the serologic testing was positive for Rickettsia typhi. The systemic and ocular findings resolved after the use of systemic antibiotics. CONCLUSION: Rickettsial diseases such as murine typhus should be included in the differential diagnosis of otherwise healthy individuals who present with an acute systemic febrile illness and retinitis or neuroretinitis. SUMMARY STATEMENT: The clinical features of two patients with serologically proven acute murine typhus with ocular involvement are presented. Both patients presented with a retinal whitening that resolved after treatment.
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Infecciones Bacterianas del Ojo , Retinitis/etiología , Tifus Endémico Transmitido por Pulgas/complicaciones , Enfermedad Aguda , Adulto , Anticuerpos Antibacterianos/análisis , Diagnóstico Diferencial , Doxiciclina/uso terapéutico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/etiología , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Norfloxacino/uso terapéutico , Retina/microbiología , Retina/patología , Retinitis/diagnóstico , Retinitis/tratamiento farmacológico , Estudios Retrospectivos , Rickettsia typhi/inmunología , Tifus Endémico Transmitido por Pulgas/diagnóstico , Tifus Endémico Transmitido por Pulgas/tratamiento farmacológicoRESUMEN
A 42-year-old immune-competent woman with orbital pseudotumor and presumed intracranial extension into the temporal lobe responded well clinically and radiologically to high-doses of corticosteroids. Five months later, she developed worsening headaches and recurrence of the temporal lobe lesion. Biopsy revealed a central nervous system (CNS) lymphoma with severe reactive gliosis abutting an area of subarachnoid lymphocytic infiltrate.
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Neoplasias Encefálicas/complicaciones , Linfoma/complicaciones , Seudotumor Orbitario/complicaciones , Adulto , Biopsia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Linfoma/diagnóstico , Linfoma/fisiopatología , Imagen por Resonancia Magnética , Seudotumor Orbitario/diagnóstico , Seudotumor Orbitario/fisiopatología , Tomografía Computarizada por Rayos X , Agudeza VisualRESUMEN
AIMS: This study was carried out to investigate the precise pattern of visual loss associated with subfoveal choroidal neovascular membranes and the mechanism by which vision is stabilised or improved after submacular surgery. METHODS: Preoperative and postoperative quantitative microperimetry using the scanning laser ophthalmoscope was performed on six eyes of five patients with age-related macular degeneration who underwent subfoveal choroidal neovascular membrane excision. The relation of the microperimetry findings to the preoperative and postoperative fluorescein angiographic features was also assessed. RESULTS: Four of the six eyes had visual improvement by the 6 month postoperative visit; the other two had stabilisation of vision at the preoperative level. Despite these beneficial visual effects, none of the patients fixated within the bed of the excised choroidal neovascular membrane. Subfoveal choroidal membrane excision was associated with a 36% average increase in the absolute scotoma at the 1 month postoperative visit, compared with the preoperative size. The postoperative scotoma appeared to remain stable or decreased slightly in size between the 6 month and 1 year postoperative visits. Recovery of vision was associated with the development of a more stable preferred eccentric fixation locus, of which the distance from the centre of the foveal avascular zone was related to final postoperative vision. Most of the eccentric fixation loci were inferotemporal to the bed of the excised choroidal neovascular membrane. The surgical retinotomy site was associated with persistent postoperative relative scotoma in five of the six cases, but resolved in one patient after 1 year. CONCLUSION: These findings indicate that quantitative scanning laser ophthalmoscope microperimetry may aid in the surgical planning of subfoveal choroidal neovascular membrane excision.
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Fondo de Ojo , Degeneración Macular/patología , Microscopía Confocal , Oftalmoscopía , Anciano , Anciano de 80 o más Años , Femenino , Fijación Ocular , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Degeneración Macular/diagnóstico , Degeneración Macular/cirugía , Masculino , Pruebas de VisiónRESUMEN
The initial clinical manifestation and subsequent pathologic characteristics of choroidal melanomas were reviewed in 20 enucleated eyes of Hispanic patients identified between 1974 and 1992. We compared them to 125 choroidal melanomas of randomly selected white patients identified over the same time period. At the time of diagnosis and at subsequent enucleation, the Hispanic patients were younger (P = .002) than the white patients. Eye pain (P = .016), red eye (P = .0002), and tearing (P = .012) were reported more commonly by the Hispanic patients, and on clinical examination the intraocular pressure was higher (P = .001) and more rubeosis iridis was noted (P < .0001) in the Hispanic patients than in the white patients. The tumors of the Hispanic patients were larger in their greatest base dimension (P = .003), and were heavily pigmented compared with those of the white patients (P = .0001). A trend toward less inflammation within the tumor and toward more epithelioid cell type was noted in the Hispanic patients.
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Neoplasias de la Coroides/etnología , Melanoma/etnología , Americanos Mexicanos , Adulto , Anciano , California , Neoplasias de la Coroides/patología , Femenino , Humanos , Presión Intraocular , Masculino , Melanoma/patología , Persona de Mediana Edad , Población BlancaRESUMEN
Macular detachment due to peripheral retinal tears that occur after pars plana vitrectomy for proliferative diabetic retinopathy can result in severe visual loss despite successful retinal reattachment. The authors reviewed the records of three patients who developed peripheral sclerotomy-related rhegmatogenous retinal detachments one to six months after vitrectomy for proliferative diabetic retinopathy, despite the absence of detectable sclerotomy-related retinal tears by indirect ophthalmoscopy and scleral depression at the conclusion of surgery. All three patients had received standard panretinal laser photocoagulation in a complete encircling pattern either prior to or during the initial vitrectomy. Clinically or echographically, each patient was seen to have a partial or complete annual peripheral sclerotomy-related rhegmatogenous retinal detachment delimited to the equator. In each of these three cases, posterior extension of the peripheral retinal detachment into the macular area was prevented by the most anterior row of the photocoagulation scars. Standard panretinal laser photocoagulation applied in a complete encircling pattern may be useful in the prophylaxis of macular detachment from sclerotomy-related retinal tears that occur after vitrectomy for proliferative diabetic retinopathy.
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Retinopatía Diabética/cirugía , Coagulación con Láser , Retina/cirugía , Desprendimiento de Retina/etiología , Desprendimiento de Retina/prevención & control , Vitrectomía/efectos adversos , Anciano , Retinopatía Diabética/diagnóstico por imagen , Femenino , Humanos , Mácula Lútea , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/cirugía , UltrasonografíaRESUMEN
The authors have occasionally noted Graves ophthalmopathy patients with stable, restrictive hypotropia who demonstrate excellent initial postoperative realignment, only to develop marked overcorrection within weeks to months after surgery. The charts of 12 consecutive patients who underwent a first operation for single, uncomplicated vertical muscle imbalance were evaluated. Five patients were identified who developed an overcorrection 2 to 5 months after surgery (overcorrected group). A stable comparison group of seven patients retained stable orthotropia after surgery. In cases of patients with late overcorrection, proptosis and superior rectus muscle volume, as measured preoperatively, were significantly greater than in the stable comparison group. There also was postoperative limitation of infraduction in most instances.
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Enfermedad de Graves/cirugía , Estrabismo/etiología , Adulto , Anciano , Diplopía/cirugía , Exoftalmia/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos Oculomotores/diagnóstico por imagen , Músculos Oculomotores/cirugía , Complicaciones Posoperatorias , Valor Predictivo de las Pruebas , Estrabismo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Transient blurring of near vision can be due to a variety of causes. We report the case of a 35-year-old man with a 10-year history of blurring of near vision that begins 30 to 45 seconds after he starts to eat and that lasts until 10 to 15 minutes after he stops eating. Magnetic resonance imaging and computed tomography of the brain and orbits did not reveal any abnormality, and stimulation of individual cranial nerves did not result in a loss of near vision. Retinoscopic refraction revealed the loss of 1.5 dioptres of accommodative power in each eye one minute after he began to eat. To the best of our knowledge such blurring of vision at near, immediately after initiating a meal, has not been previously reported. The neuroanatomy of the accommodation and of the gustatory pathways are discussed, as they may relate to this patient's visual complaint.
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Ingestión de Alimentos/fisiología , Presbiopía/fisiopatología , Acomodación Ocular/fisiología , Adulto , Nervios Craneales/fisiopatología , Humanos , Masculino , Factores de TiempoRESUMEN
Exophthalmos is the most commonly measured sign of Graves ophthalmopathy, whereas enlargement of the extraocular muscles is the principal pathologic abnormality. The purpose of this article is to explore possible etiologies of increased volume of orbital fat and of proptosis in patients with no substantially increased total extraocular muscle volume. Computed tomographic scans of the 13 orbits reviewed in this study had the following characteristics in common: a fine, reticular pattern within the orbital fat, a prominent superior ophthalmic vein, and an enlarged superior rectus muscle. Quantitative analysis revealed that superior rectus muscle volume showed a statistically significant correlation with proptosis, whereas medial, lateral, and inferior rectus muscle volumes did not correlate with proptosis. Based on anatomic considerations, the authors postulate that superior rectus muscle enlargement alone may produce reduced venous outflow from the orbit, thereby expanding the apparent orbital fat volume and producing proptosis.
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Enfermedad de Graves/complicaciones , Miositis/complicaciones , Músculos Oculomotores/patología , Órbita/irrigación sanguínea , Adolescente , Adulto , Constricción Patológica/etiología , Exoftalmia/etiología , Femenino , Enfermedad de Graves/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Miositis/diagnóstico por imagen , Músculos Oculomotores/diagnóstico por imagen , Órbita/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Venas/patologíaRESUMEN
By establishing an employee's alcoholism program, Montefiore Hospital and Medical Center (MHMC) has reduced absenteeism, increased productivity, improved the supervisory process, and, in most instances, enabled rehabilitated alcoholics to satisfactorily perform their jobs. The rationale, policy, components, and administration of this program can be replicated in any health care institution that is committed to the personal well-being of its employees and to the quality of its services.