Extra-medullary hematopoiesis causing bilateral optic atrophy in beta thalassemia/Hb E disease.

OBJECTIVE: To report a rare presentation of bilateral optic nerve compression from extra-medullary hematopoiesis in beta thalassemia/Hb E disease. DESIGN: Interventional case report. CLINICAL PRESENTATION: A 13-year-old Thai girl was reported with slowly progressive bilateral visual loss due to optic neuropathy as a result of compression from extra-medullary hematopoiesis. Computed tomography of orbit and brain revealed a homogeneous enhancing midline soft tissue mass originating from the ethmoid and sphenoid sinuses along with extensive involvement of the skull. INTERVENTION: Blood transfusion once every month and low-dose radiotherapy to sphenoid and ethmoid bones with some visual improvement. CONCLUSION: Extra-medullary hematopoiesis in beta thalassemia can involve paranasal sinuses and cause compressive neuropathy. In patients with beta thalassemia that required multiple blood transfusions with progressive visual loss, ectopic marrow compression of optic nerve should be ruled out.

Squamous cell carcinoma of the lacrimal sac: a case report.

Lacrimal sac tumors are rare tumors of the periorbital region. The authors report a case of squamous cell carcinoma of the lacrimal sac in a 47-year-old Thai man. The patient presented with epiphora and a palpable mass in the medial canthal area. The diagnosis was confirmed by the pathological studies. Radical surgery and radiation therapy were given. Early detection and long-term follow-up are necessary.

Intravitreal angiostrongyliasis: report of 2 cases.

Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as Angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. Fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.

Epidemiology of the ocular complications of HIV infection in Chiang Mai.

OBJECTIVE: To identify the magnitude of ocular complications in HIV infection in Chiang Mai, and determine the signs or symptoms that indicate the risk factors for developing ocular complications in HIV-positive patients METHOD: A prospective study was carried out in newly diagnosed HIV-positive patients seen in the Ocular Infectious Disease Clinic of Maharaj Nakorn Chiang Mai Hospital from March 1, 2000 through February 28, 2001. A complete ophthalmic examination was performed on each patient together with a systemic evaluation of present illness and current medications. RESULTS: Three-hundred and ninety-five HIV-positive patients were seen for ophthalmic evaluation. Of these, 90 were in stage A (asymptomatic), 84 were in stage B (symptomatic), and 221 were in stage C (AIDS). Ocular complications were found in 44.6 per cent of the patients. Cytomegalovirus (CMV) retinitis was the most common ophthalmic complication (33%). Other ocular complications included cotton wool spot (8%), uveitis (4%), optic neuropathy (3%), and keratoconjunctivitis sicca (2%). The clinical presenting symptoms, which were the indicators for ocular complications and CMV retinitis, included chronic cough, oral thrush, chronic diarrhea, weight loss, wasting, and skin disorders. Ocular symptoms, which indicated a high risk of developing CMV retinitis, included flashing, floaters, and scotoma. CONCLUSIONS: Ocular complications are common in HIV-positive patients. CMV retinitis, which is a major vision-threatening problem, represented the most common finding. It is recommended that HIV-positive patients should have their eyes examined regularly, particularly when they have the clinical presenting symptoms previously mentioned. The patients should also notice early symptoms of CMV retinitis, which includes flashing, floaters, and scotoma.