ABSTRACT
PURPOSE: To report a case of neovascular and angle closure glaucoma secondary to breast cancer metastatic to the iris that was successfully treated with injections of intravitreal bevacizumab (Avastin) 1.25 mg/0.05 mL. METHODS: Case report. PATIENTS: A 47-year-old woman with metastatic breast cancer presented to The New York Eye Cancer Center with left ocular pain, photosensitivity, vision loss, and multiple iris nodules. Her intraocular pressure was uncontrolled. Gonioscopy revealed neovascularization of the iris and angle; no choroidal neovascularization was noted. Ultrasound biomicroscopy demonstrated tumor invasion of iris stroma with marked anterior uveal thickening and narrowed angles. RESULTS: Three monthly injections of intravitreal bevacizumab resulted in nearly complete resolution of iris neovascularization, reduction of intraocular pressure, and control of tumor (although a small amount of residual tumor remained). CONCLUSION: Intravitreal anti-vascular endothelial growth factor therapy for breast cancer metastatic to the iris with secondary neovascular glaucoma provided good local control for a limited follow-up period, because the patient died because of systemic complications of her disease.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Bevacizumab/administration & dosage , Breast Neoplasms/pathology , Glaucoma, Angle-Closure/drug therapy , Iris Neoplasms/drug therapy , Iris Neoplasms/secondary , Neovascularization, Pathologic/drug therapy , Fatal Outcome , Female , Humans , Intravitreal Injections , Middle Aged , Treatment OutcomeABSTRACT
Ocular toxoplasmosis is the most common cause of posterior uveitis in the United States and worldwide. It commonly follows a relapsing course with the potential for multiple adverse visual sequelae and, rarely, blindness. Both immune-competent and immune-suppressed populations can develop severe relapsing disease. There is considerable debate regarding the initial treatment of ocular toxoplasmosis in both groups, with multiple antiparasitic agents commonly used with little evidence to support any particular regimen. The precise role of corticosteroids in treatment also has yet to be rigorously defined. Secondary prevention is commonly implemented in the immune suppressed population, but there is a lack of level one evidence to support its role in immune-competent patients, though it warrants future investigation.
ABSTRACT
PURPOSE: To quantify and characterize eye injuries related to aerosol container consumer products treated in United States hospital emergency departments (EDs) from 1997 through 2009. DESIGN: Retrospective study. METHODS: Descriptive analysis of aerosol container-related eye injury data derived from the National Electronic Injury Surveillance System, a stratified probability sample of hospital-affiliated United States EDs. Data collected included demographic variables (gender and age), locale, diagnoses, and hospital disposition associated with aerosol container-related eye injuries treated in United States EDs from 1997 through 2009. Products associated with injury and mechanisms of injury also were extracted and analyzed. RESULTS: There were an estimated 10 765 (95% confidence interval [CI], 9842 to 11 688) visits to United States EDs for aerosol container-related eye injuries during the study period; 6756 (95% CI, 5771 to 7742; 63%) patients were male; 5927 (95% CI, 4956 to 6897; 55%) injuries occurred in children (age < 18 years). The most common product was spray paint, accounting for 2048 (95% CI, 1402 to 2694; 19%) injuries. The most common mechanism of injury was self-inflicted spray to the eye, occurring in 4649 (95% CI, 3746 to 5552; 43%) cases. The most common diagnosis was dermatitis or conjunctivitis, occurring in 3880 (95% CI, 2995 to 4765; 36%) cases. CONCLUSIONS: This study suggests that most aerosol container-related eye injuries in the United States occur in men and children and that self-inflicted spray to the eye is the most common mechanism of injury. Further research is needed to devise effective prevention strategies for these types of injuries.
Subject(s)
Aerosols/adverse effects , Eye Injuries/etiology , Nebulizers and Vaporizers , Adolescent , Adult , Child , Child, Preschool , Consumer Product Safety , Emergency Service, Hospital/statistics & numerical data , Eye Injuries/epidemiology , Female , Household Products/adverse effects , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , United States/epidemiology , Young AdultABSTRACT
The authors present a single-patient interventional case report of endogenous fungal endophthalmitis (EFE) in a patient with an implanted prosthetic device. A 74-year-old man underwent a double coronary artery bypass graft with a bioprosthetic pericardial valve and transvenous dual chamber pacemaker. Four months later, he presented with EFE. Despite aggressive local and systemic antifungal therapy, the patient died of septic shock due to a fungally infected pacemaker. Successful management of post-cardiac surgery EFE requires aggressive local and systemic antifungal therapy, but without surgical removal of implanted thoracic hardware these modalities alone may be insufficient for a cure.