[Retinitis due to cytomegalovirus in AIDS]. / Zapalenie siatkówki wywolane wirusem cytomegalii w przebiegu AIDS.

Clinical course of 4 AIDS patients suffering from CMV retinitis is presented. Two patients were treated with ganciclovir, one died before starting the treatment and one was vitrectomized with silicone oil injection. Of the two patients treated with ganciclovir one improved significantly when the other continued to deteriorate and died after 8 months of follow-up. Early diagnosis and treatment of patients with zone I involvement gives the best chances for improvement. Mean life expectancy in aids patients after diagnosis of CMV retinitis is 7-10 months.

Postoperative endophthalmitis secondary to Candida parapsilosis. A case treated by vitrectomy and intravitreous therapy.

A 79-year-old woman developed Candida parapsilosis endophthalmitis nine weeks after an uneventful cataract extraction. The diagnosis was suspected on clinical examination and documented by culture of the vitreous biopsy obtained during vitrectomy. The endophthalmitis was treated by pars plana vitrectomy and intravitreous injection of amphotericin B and dexamethasone. The patient was also treated with systemic flucytosine, to which the operative isolate proved resistant. This was therefore immediately discontinued; however, the intraocular infection cleared rapidly after the initial vitrectomy and intravitreous injection. The patient's visual acuity ultimately returned to 20/20. The combination of these two newer methods of treatment for fungal endophthalmitis achieved a favorable outcome in a disease process that has often previously wrought disaster.

Diabetic papillopathy and proliferative retinopathy.

Diabetic papillopathy has been characterized as a syndrome in which predominantly young, insulin-dependent diabetics develop transient edema of the optic disc with minimal impairment of the function of the optic nerves. In this study, four patients with long-standing insulin-dependent diabetes mellitus and acute disc swelling in one or both eyes were evaluated. The most unusual finding in these cases was that three had proliferative retinopathy either at the time the disc edema was discovered or very shortly afterwards. The fourth patient also developed this condition subsequently. It is important to be aware of diabetic papillopathy and to recognize the condition early enough so that the patient may be spared unnecessarily extensive neurological evaluations and invasive procedures. Patients with diabetic papillopathy should be closely observed so that the presence or development of proliferative retinopathy may be established.

Retinal detachment secondary to branch vein occlusion: Part I.

Eight patients with retinal detachment secondary to branch vein occlusion were studied. Retinal detachment secondary to branch vein occlusion occurs when the vein occlusion is severe and there is marked capillary nonperfusion and leakage. The detachment is limited to the area of the occluded vein and does not extend beyond the equator. Usually the detachment is shallow; however, it can be bullous as demonstrated in 3 of our patients. Fluorescein angiography revealed the typical findings associated with branch vein occlusion, in addition to late pooling of the dye into the fluid in the subretinal space. In each of the 6 cases treated by laser photocoagulation, reattachment of the retina occurred. The disease is discussed from the standpoint of ocular findings, fluorescein angiography, diagnosis and differential diagnosis, course, treatment, and prognosis.

Cotton-wool spots and the early diagnosis of giant cell arteritis.

BACKGROUND: Giant cell arteritis is a common cause of severe visual loss in older individuals. Patients often present to the ophthalmologist having already lost vision in one eye. Detection of early ophthalmoscopic signs that precede irreversible visual loss in giant cell arteritis would allow preventative treatment in an otherwise frequently blinding disease. METHODS: Case presentations. RESULTS: Seven patients with mild visual symptoms and results of an ophthalmologic examination significant for cotton-wool spots were found to have giant cell arteritis. On specific questioning, six of seven patients described constitutional symptoms consistent with giant cell arteritis. Six patients had an abnormally elevated Westergren erythrocyte sedimentation rate. Temporal artery biopsy confirmed giant cell arteritis in six patients. The seventh patient received a diagnosis of polymyalgia rheumatica. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots in all seven patients. CONCLUSION: Cotton-wool spots are an early ophthalmoscopic finding in giant cell arteritis and can precede severe visual loss. Recognition of the significance of cotton-wool spots, use of laboratory studies, and prompt treatment may preserve vision in an otherwise frequently blinding disease.