CHANGES OF OUTER RETINAL THICKNESS WITH INCREASING AGE IN NORMAL EYES AND IN NORMAL FELLOW EYES OF PATIENTS WITH UNILATERAL AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To test the hypothesis that the thickness of outer retinal layers will change with increasing age in normal eyes and in the normal fellow eyes of patients with unilateral age-related macular degeneration. METHODS: Spectral domain optical coherence tomography images of 127 normal eyes of 127 subjects and 58 normal fellow eyes of 58 patients with unilateral age-related macular degeneration were studied. The thickness between the retinal pigment epithelium line and the cone outer segment tips line, between the cone outer segment tips line and the photoreceptor inner segment/outer segment line, and between the inner segment/outer segment line and the external limiting membrane line were measured at the fovea in both groups. RESULTS: The thickness between retinal pigment epithelium line and the cone outer segment tips line, and between inner segment/outer segment line and the external limiting membrane line were significantly and negatively associated with age in the normal group. Cone outer segment tips line and the photoreceptor inner segment/outer segment thickness was not significantly associated with age. Retinal pigment epithelium line and the cone outer segment tips line was thinner in the fellow eyes of patients with unilateral age-related macular degeneration than in the age-matched normal eyes. Cone outer segment tips line and the photoreceptor inner segment/outer segment and inner segment/outer segment line and the external limiting membrane line thicknesses in the fellow eyes were not significantly different from that of normal eyes. CONCLUSION: The tissue between the retinal pigment epithelium line and the cone outer segment tips line may become atrophic in older eyes and in the normal fellow eyes of patients with unilateral age-related macular degeneration.

[Case report of nocardia brain abscess that needs to be distinguished from metastatic brain tumor].

We report a 62-year-old woman presenting with nocardia brain abscess that mimics metastatic brain tumor. Six months before admission to our hospital, she presented with persistent hemoptysis, and a friable endobronchial mass was detected at another hospital. However, a definite diagnosis had not been made, and then she presented with hemianopia. Her laboratory analysis results showed that she had no immunological abnormalities. T1-weighted magnetic resonance images of the brain with Gd-DTPA revealed hyperintensive multiple masses with surrounding edema. We suspected this case as metastatic brain tumor of unknown origin, and the patient underwent biopsy of the supraclavicular lymph node. Histopathology results indicated abscess, and gram staining of material obtained from the abscess showed Gram-variable rods, which were determined upon culture as acid-fast Gram-positive branching rods and identified as Nocardia asteroides. Accordingly, we diagnosed the patient as having nocardia brain abscess, and she was treated with an oral antibiotic (TMP-SMX). Four months later, the abscesses disappeared. The patient recovered after prolonged TMP-SMX therapy with no recurrence in over 9 months.