RESUMEN
AIMS: To describe the clinical course and treatment of Haemophilus influenzae associated scleritis. METHODS: Retrospective case series. RESULTS: Three patients developed scleritis associated with ocular H influenzae infection. Past medical history, review of systems, and laboratory testing for underlying collagen vascular disorders were negative in two patients. One patient had arthritis associated with an antinuclear antibody titre of 1:160 and a Westergren erythrocyte sedimentation rate of 83 mm in the first hour. Each patient had ocular surgery more than 6 months before developing scleritis. Two had cataract extraction and one had strabismus surgery. Nodular abscesses associated with areas of scleral necrosis were present in each case. Culture of these abscesses revealed H influenzae in all patients. Treatments included topical, subconjunctival, and systemic antibiotics. Scleral inflammation resolved and visual acuity improved in each case. CONCLUSION: H influenzae infection may be associated with scleritis. Accurate diagnosis and treatment may preserve ocular integrity and good visual acuity.
Asunto(s)
Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones por Haemophilus/tratamiento farmacológico , Escleritis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Infecciones por Haemophilus/complicaciones , Humanos , Estudios Retrospectivos , Escleritis/microbiología , Agudeza VisualRESUMEN
PURPOSE: To describe the clinical and fluorescein angiographic appearance of cystoid macular edema associated with cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). METHODS: We retrospectively examined the clinical and photographic records of four patients with AIDS and cytomegalovirus retinitis who developed cystoid macular edema. RESULTS: Seven eyes of four patients with AIDS and cytomegalovirus retinitis experienced decreased vision associated with cystoid macular edema. Vitreous inflammation was mild in each patient. In all eyes, the retinitis involved zone 1, and in all but one eye, the cytomegalovirus retinitis was inactive. In one eye, the cystoid macular edema was worsened by formation of a dense juxtafoveal epiretinal membrane. CONCLUSIONS: Although infrequently recognized, cystoid macular edema can cause visual loss in patients with AIDS and cytomegalovirus retinitis. Fluorescein angiography should be considered in any patient with cytomegalovirus retinitis and unexplained visual loss.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Retinitis por Citomegalovirus/complicaciones , Edema Macular/etiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Acetazolamida/uso terapéutico , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Antivirales/uso terapéutico , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/inmunología , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Retinitis por Citomegalovirus/tratamiento farmacológico , Retinitis por Citomegalovirus/patología , Angiografía con Fluoresceína , Foscarnet/uso terapéutico , Fondo de Ojo , Ganciclovir/uso terapéutico , Humanos , Ketorolaco Trometamina , Edema Macular/tratamiento farmacológico , Edema Macular/patología , Masculino , Estudios Retrospectivos , Tolmetina/análogos & derivados , Tolmetina/uso terapéutico , Trometamina/análogos & derivados , Trometamina/uso terapéutico , Agudeza VisualAsunto(s)
Antiinflamatorios/uso terapéutico , Enfermedad de Crohn/complicaciones , Glucocorticoides/uso terapéutico , Vena Retiniana/patología , Vasculitis/etiología , Administración Tópica , Adulto , Antivirales/uso terapéutico , Retinitis por Citomegalovirus/tratamiento farmacológico , Retinitis por Citomegalovirus/etiología , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/etiología , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Herpes Simple/tratamiento farmacológico , Herpes Simple/etiología , Humanos , Inmunosupresores/uso terapéutico , Papiledema/etiología , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/etiología , Enfermedades de la Retina/patología , Vena Retiniana/efectos de los fármacos , Oclusión de la Vena Retiniana/etiología , Retinitis/tratamiento farmacológico , Retinitis/virología , Vasculitis/tratamiento farmacológico , Vasculitis/patologíaRESUMEN
OBJECTIVE/DESIGN: To evaluate prospectively the ability of three retina specialists to detect recurrent choroidal neovascularization (CNV) after clinical examination alone and then with fluorescein angiography at 3 and 6 weeks and at 3, 6, 9, and 12 months after laser photocoagulation. SETTING: Single tertiary retinal referral center. PATIENTS: All patients who had laser treatment for CNV within 14 months of their study visit. One hundred thirty-seven eyes of 134 patients were evaluated during 401 visits. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, and negative predictive value of clinical examination with biomicroscopy to detect recurrent CNV when defined as leakage on the periphery of the laser-treated area on the fluorescein angiogram. RESULTS: Ninety-seven definite or probable recurrences in 56 eyes were identified on the fluorescein angiogram. Clinical examination had a sensitivity of 59%, specificity of 94%, positive predictive value of 76%, and negative predictive value of 88%. These figures varied somewhat by underlying cause, age, time since treatment, and lesion location. Using either a reported or measured loss of vision with the results of biomicroscopy as an indication of recurrence increased the sensitivity to 77% but reduced the specificity to 81%. CONCLUSIONS: Clinical examination probably cannot replace fluorescein angiography in detecting all recurrent CNV after laser treatment. However, for follow-up visits in which recurrent CNV was not suspected on biomicroscopy, definite or questionable recurrent CNV was identified on the fluorescein angiogram only 12% of the time, while the absence of recurrent CNV using this method was confirmed 88% of the time.