Prevalence and significance of acquired immunodeficiency syndrome-related retinal microvasculopathy.

We performed ophthalmologic examinations on 127 subjects with or at risk for human immunodeficiency virus (HIV) infection over a one-year period to determine the prevalence and significance of retinal cotton-wool spots and hemorrhages (AIDS-related retinal microvasculopathy). Of 26 asymptomatic homosexual men, of whom 13 were HIV seronegative and 13 were HIV seropositive, none manifested this retinopathy. Three of 34 patients (9%) with AIDS-related complex and 29 of 67 patients (43%) with AIDS manifested retinopathy on the initial examination. This difference in the prevalence of retinopathy between groups was statistically significant (P less than .05). Patients with AIDS demonstrated 7.2 times greater odds of manifesting retinopathy than patients with AIDS-related complex (P less than .05). Within the group of patients with AIDS, the T helper (CD4) to suppressor (CD8) cell ratio was significantly associated with retinopathy at the initial ocular examination. The CD4:CD8 ratio of the total group of AIDS and AIDS-related complex patients with retinopathy was significantly lower than that of patients without retinopathy (P less than .05). There was no significant association between retinopathy and any specific past or concurrent opportunistic infection or neoplasm. The presence of retinopathy was not associated with symptoms in any patient. The lesions of AIDS-related retinal microvasculopathy may be an important finding in the evaluation of patients suspected to have HIV-related disease.

Bed rest versus activity ad lib in the treatment of small hyphemas.

The management of small hyphemas remains controversial. Some authors advocate hospitalization, strict bed rest, and medical therapy with aminocaproic acid. Others are less conservative and recommend treatment on an ambulatory basis without the drug. In order to establish the overall rebleed rate for small hyphemas and to assess whether or not strict bed rest improves the prognosis, we studied 73 patients with small hyphemas occupying less than one third of the anterior chamber. Thirty-seven patients, during the first year of the study, were hospitalized and treated with strict bed rest while 36 patients, during the second year, were hospitalized but allowed to ambulate freely. The overall incidence of rebleeds was 15% (11 of 73). The incidence of rebleeds and other complications was not statistically different between the two study groups. Additionally, the final visual acuity in both groups was essentially identical. We conclude that bed rest does not improve the prognosis in cases of small hyphemas.

Ocular drug bioavailability from topically applied liposomes.

During the past decade liposomes have been investigated extensively for their ability to improve drug utilization by the body, first in the area of chemotherapeutics and most recently in the area of ophthalmology. Liposomes are vesicle-like structures with a concentric series of alternating compartments of aqueous spaces and phospholipid bilayers. To date, liposomes have been found to both promote and reduce ocular drug absorption, indicating that a definite need exists for further studies to evaluate the interplay of drug, liposomes, and the corneal surface in determining the effectiveness of liposomes as vehicles for topically applied ophthalmic drugs. The purpose of this review is to place in perspective the role of liposomes in topical ocular drug delivery. As background material, the factors influencing ocular drug bioavailability and the features of liposomes pertinent to their effectiveness as drug carriers are reviewed.

Surgical treatment of chronic pancreatitis. Twenty-two years' experience.

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).