RESUMEN
PURPOSE: To report a case of presumed gemcitabine-induced retinopathy and nephropathy. METHODS: Case Report. Retrospective chart review. RESULTS: A 64-year-old woman with a recent diagnosis of metastatic cholangiocarcinoma presented with progressive visual loss and renal failure shortly after the initiation of a chemotherapy regimen which included gemcitabine. Clinical examination and fluorescein angiography showed findings of severe retinal ischemia. CONCLUSION: Although gemcitabine chemotherapy has been reported to cause a Purtscher-like retinopathy, we propose in our patient a gemcitabine-induced vasculopathy that lead to significant retinal and renal ischemia.
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Antimetabolitos Antineoplásicos/efectos adversos , Desoxicitidina/análogos & derivados , Fallo Renal Crónico/inducido químicamente , Enfermedades de la Retina/inducido químicamente , Trastornos de la Visión/inducido químicamente , Desoxicitidina/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , GemcitabinaRESUMEN
BACKGROUND: Paintball-related ocular injuries result in severe damage and loss of vision. Despite efforts to increase public awareness and improve safety features, the incidence of eye injuries has increased over time. We examined the characteristics and ocular effects of paintball injury at our tertiary referral center. METHODS: Retrospective review of charts of patients with paintball injury between 1998-2005. RESULTS: Fourteen patients were evaluated for paintball injury; 13 (93%) were male and one (7%) was female. Average age was 17 years (range from 9 to 30). Thirteen patients (95%) did not wear eye protection; one is unknown. Injuries occurred while playing paintball in three patients (21%); ten (71%) were injured in either accidental (four patients) or intentional (six patients) shootings not associated with play. Minimum follow-up was 6 weeks, except for one patient who was lost to follow-up. Seven patients (50%) had final visual acuity (VA) better than 20/200, six patients (43%) were 20/200 or worse, and information on one patient was not available. VA, except in one case, improved with treatment. Decreased VA in this case was due to proliferative vitreoretinopathy (PVR). Hyphema was noted in ten patients (71%), vitreous hemorrhage in eight (57%), retinal hemorrhage in six (43%), retinal tear or detachment in six (43%), commotio retinae in six (43%), iris injury in five (36%), keratopathy in four (29%), lens injury in two (14%), subluxation of lens in two (14%), secondary glaucoma in two (14%), open globe/intraocular foreign body (IOFB) in one (7%), choroidal rupture in one (7%), and proliferative vitreoretinopathy (PVR) in one (7%). Ten patients (71%) required intervention (surgery, laser retinopexy or cryotherapy). CONCLUSION: Paintball trauma results in significant ocular injury and loss of vision. Most injuries occur in unsupervised settings without proper eye protection. Ten patients (71%) were injured in accidental or intentional shootings. Lack of supervision and use of paintball materials as assault weapons make the risk for ocular injury more significant. Improved safety features of paintball equipment, along with continued education of proper eye protection, may reduce the incidence of severe ocular injuries.
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Traumatismos en Atletas/etiología , Lesiones Oculares/etiología , Juego e Implementos de Juego/lesiones , Heridas no Penetrantes/etiología , Adolescente , Adulto , Traumatismos en Atletas/cirugía , Niño , Lesiones Oculares/cirugía , Dispositivos de Protección de los Ojos , Femenino , Estudios de Seguimiento , Humanos , Hipema/etiología , Hipema/cirugía , Masculino , Pintura , Enfermedades de la Retina/etiología , Enfermedades de la Retina/cirugía , Estudios Retrospectivos , Agudeza VisualRESUMEN
PURPOSE: To describe the clinical course of a case of intravascular lymphoma. DESIGN: Case report. METHODS: Retrospective chart review. RESULTS: A 56-year-old man presented with blurry vision associated with fever and decreased hearing. Ocular exam including fluorescein angiography and OCT was consistent with Vogt-Koyanagi-Harada syndrome and the patient initially improved with corticosteroids. Clinical deterioration led to further systemic workup and revealed intravascular lymphoma. The patient was started on chemotherapy with resolution of visual complaints. CONCLUSIONS: Intravascular lymphoma can present as a masquerade of VKH syndrome. Diagnosis can be aided with measurement of LDH and skin biopsy.
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Linfoma/diagnóstico , Síndrome Uveomeningoencefálico/diagnóstico , Neoplasias Vasculares/diagnóstico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Vasos Sanguíneos/patología , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Doxorrubicina/uso terapéutico , Angiografía con Fluoresceína , Humanos , L-Lactato Deshidrogenasa/sangre , Linfoma/complicaciones , Linfoma/tratamiento farmacológico , Linfoma/enzimología , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Rituximab , Piel/patología , Resultado del Tratamiento , Neoplasias Vasculares/complicaciones , Neoplasias Vasculares/tratamiento farmacológico , Neoplasias Vasculares/enzimología , Vincristina/uso terapéutico , Trastornos de la Visión/etiologíaRESUMEN
BACKGROUND: Sun glare decreases athletes' contrast sensitivity and impairs their ability to distinguish objects from background. Many commercial products claim to reduce glare but have not been proven effective in clinical studies. OBJECTIVE: To determine whether glare-reducing products such as eye black grease and antiglare stickers reduce glare and improve contrast sensitivity during sunlight exposure. DESIGN AND METHODS: We tested 46 subjects for contrast sensitivity using a Pelli-Robson contrast chart. Each subject served as an internal control and then was randomized to either application of eye black grease, antiglare stickers, or petroleum jelly at the infraorbital rim. All testing was performed in conditions of unobstructed sunlight. RESULTS: Analysis of variance revealed a significant difference between eye black grease (mean +/- SD, Pelli-Robson value, 1.87 +/- 0.09 logMAR units) and antiglare stickers (1.75 +/- 0.14 logMAR units) in binocular testing (P =.02). No statistical difference was found between the groups in right eyes, left eyes, or in combined data from the right and left eyes. Paired t tests demonstrated a significant difference between control (mean +/- SD, 1.77 +/- 0.14 logMAR units) and eye black grease (1.87 +/- 0.09 logMAR units) in binocular testing (P =.04). There was also a significant difference between control (mean +/- SD, 1.65 +/- 0.05 logMAR units) and eye black grease (1.67 +/- 0.06 logMAR units) in combined data from the right and left eyes (P =.02). CONCLUSION: Eye black grease reduces glare and improves contrast sensitivity in conditions of sunlight exposure compared with the control and antiglare stickers in binocular testing.