Bilateral endogenous Candida endophthalmitis after induced abortion.

AIM: Analysis of the development and treatment of bilateral Candida endophthalmitis after induced abortion in a healthy 31-year-old patient. METHOD: A diagnosis of bilateral Candida endophthalmitis was established on the basis of positive vaginal culture, serological finding, and culture for Candida hyphae from the vitreous aspirate. The treatment of the disease consisted of prolonged systemic therapy with amphotericin B and fluconazole and pars plana vitrectomy with intravitreal amphotericin B injection. RESULTS: After the combined systemic therapy with antibiotics, fungistatics, and corticosteroids proved to be insufficient, pars plana vitrectomy with intravitreal instillation of amphotericin B was performed, which led to the improvement of visual function. After surgery, visual function was maintained with prolonged systemic therapy with fluconazole and methylprednisolone. CONCLUSION: Complicated induced abortion may cause bilateral Candida endophthalmitis in a young healthy woman. Elimination of the cause of fungemia and adequate systemic treatment did not cure bilateral endophthalmitis. Pars plana vitrectomy with intravitreal instillation of 5-microg amphotericin B proved as a method of choice in treating this severe ophthalmic disease.

Types of central serous retinopathy, analysis of shape, topographic distribution and number of leakage sites.

The analysis of 212 fluorescein angiograms of the same number of eyes showed that Type I is by far the most prevalent form of central serous retinopathy. Type I appeared in 92.45%, Type II in 6.60% and the Intermediate type in 0.95% of the examined eyes. The patients were mostly male (81.13%) between 30 and 49 years of age (95.28%). The number of leakage sites in Type I central serous retinopathy varied from 1 (83.67%) to 5 (1.02%). Solitary leakage appeared in 83.67%, while uniform spreading of fluorescein into the subretinal blister in Type I central serous retinopathy appeared in 85.71% of eyes. Most leakage sites (32.50%) were located in the upper nasal quadrant, while the lower temporal quadrant was least affected (15.83%). The foveal avascular zone was affected in 4.14% and the papillomacular bundle in 20.83% of the examined eyes.

Brachytherapy--optional treatment for choroidal neovascularization secondary to age-related macular degeneration.

Age-related macular degeneration (ARMD) presents the main cause of irreversible loss of central vision in older population, due to a progressive neuroretinal damage and damage of retinal pigment epithelium of foveal area. This observation emphasizes the insufficiency of all presently used therapeutic procedures. Therefore, investigation has been conducted at the University Eye Clinic Zagreb for the last three years testing the effects of brachytherapy with direct episcleral application of ruthenium applicators to the posterior pole of the globe. Forty-two patients aged 58-79 were followed for a min. of 12 months. During this period their central visual acuities remained stable. Six patients showed one-line improvement of visual acuity and 8 patients showed no changes. Twenty-one patient lost 1-2 lines of visual acuity and 7 patients lost more than 2 lines. According to this we can conclude that patients treated with brachytherapy showed significantly better results compared to the control subjects, which is very encouraging.

A new approach to surgical treatment of diabetic retinopathy.

Results of surgical treatment performed in 48 patients with proliferative diabetic retinopathy are presented. The technique of excision and vitrectomy of the posterior cortex and neovascular membranes was used in a single act. The authors are inclined to believe that membranes can be more completely and with less bleeding removed using this technique than with the technique of circumcision and segmentation. The procedure was most frequently complicated by perioperative formation of posterior ruptures (13 patients) and peripheral ruptures (11 patients). All ruptures were treated by endolaser photocoagulation. Additional or panretinal photocoagulation was carried out when necessary. During the postoperative period, retina remained attached in 33 patients, whereas in 15 patients complications in terms of reproliferation and neovascular glaucoma occurred.

Risk factors in nonarteritic anterior ischemic optic neuropathy.

The authors have investigated risk factors associated with the occurrence of nonarteritic anterior ischemic optic neuropathy (AION) in 83 patients and 124 eyes. 12% of the patients with nonarteritic AION had diabetes mellitus, 37.3% hypertension, 14.5% atherosclerosis, while the rest (36.2%) were classified as idiopathic. The incidence of bilateral AION was slightly less than 50%. The period in which both eyes get affected is usually 1-2 months or longer. Nonarteritic AION can occur at any age, therefore it is seen in young people as well. The role of arterial hypertension and diabetes in pathogenesis of AION is still to be determined.