Encircling photothrombotic therapy for choroidal Greene melanoma using rose bengal.

The photosensitizing dye rose bengal in combination with an argon green laser (514.5 nm) operated at low power was evaluated in 49 rabbit eyes for treatment of experimental choroidal Greene melanoma by circumferential occlusion of the choroidal vasculature. The effects of no treatment, laser alone, and rose bengal alone were observed in 16 control eyes, all of which showed rapid tumor growth. Immediately following rose bengal injection, 3 minutes of continuous irradiation at 20.4 W/cm2 (500-microns spot, 40 mW) applied in three to four circumferential revolutions around the base of tumor nodules, without direct tumor irradiation, produced peripheral vascular occlusion and consequent tumor inhibition. Similar therapy at higher laser intensity (30.6 W/cm2) and with multiple retreatment sessions (28.0 to 30.6 W/cm2) resulted in increased tumor-inhibiting effect. Low-dose rose bengal phototherapy did not appear to directly damage ocular tissues adjacent to treatment areas; however, when multiple irradiation sessions were given within a short interval, an increased incidence of retinal detachment was observed.

The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host.

Nine patients with active ocular or optic nerve involvement by syphilis who also had concurrent human immunodeficiency virus type-1 (HIV-1) infection are described. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in four of nine cases. Fifteen eyes were affected. Ocular manifestations were: iridocyclitis in three eyes, vitreitis in one eye, retinitis or neuroretinitis in five eyes, papillitis in two eyes, optic perineuritis in two eyes, and retrobulbar optic neuritis in two eyes. Three patients diagnosed with acquired immune deficiency syndrome (AIDS) had the worst initial visual acuities. Six of nine patients had evidence of concomitant central nervous syndrome (CNS) involvement with syphilis. Benzathine penicillin was administered intramuscularly to three patients. All three had relapses. Seven of nine patients treated intravenously with high-dose penicillin had dramatic responses to therapy with improvement in vision and serologies and no evidence of relapse. Regimens accepted for the treatment of neurosyphilis appear to be adequate for the treatment of ocular syphilis in HIV-1-infected patients though further long-term follow-up will be required.

Optic neuropathy in uremia.

We examined three patients who developed optic neuropathies while undergoing chronic hemodialysis. One patient developed severe bilateral deterioration of vision, but recovered totally four weeks after discontinuing deferoxamine chelation therapy. Another patient had bilateral visual loss associated with chronic papilledema of idiopathic increased intracranial pressure. A third showed atypically severe consecutive anterior ischemic optic neuropathy. The latter two patients showed little improvement with high-dose intravenous methylprednisolone therapy combined with more vigorous hemodialysis. These cases, in addition to those previously described, underscore the heterogeneity of optic nerve disease in patients with uremia.