Cytomegalovirus retinitis in a patient with Wegener's granulomatosis.

Cytomegalovirus retinitis (CMVR) is a rare complication of systemic immunosuppressive therapy in patients with rheumatic disorders. We describe a 44-year-old man with Wegener's granulomatosis who was treated with cyclophosphamide and methylprednisolone and who subsequently developed bilateral CMVR. In spite of discontinuation of immunosuppressive therapy and administration of systemic ganciclovir, retinitis recurred and maintenance therapy was needed. In conclusion, increased awareness of this potentially serious complication of immunosuppressive therapy is critical. If immune recovery is slow after discontinuation of immunosuppressive agents, prolonged antiviral therapy is required in order to prevent recurrences of CMVR.

Prevalence of factor V Leiden in patients with retinal vein occlusion.

PURPOSE: Factor V Leiden mutation is a common genetic defect associated with a tendency to venous thrombosis. The aim of this study was to evaluate the prevalence of factor V Leiden in patients with retinal vein occlusion (RVO). METHODS: Blood samples were obtained from fifty RVO patients and were tested for factor V Leiden using DNA analysis. Twenty-three patients had central RVO (CRVO), twenty-five had branch RVO (BRVO) and two had CRVO in one eye and BRVO in the other eye. RESULTS: DNA analysis showed that only 4 patients (8%) were heterozygous carriers of factor V Leiden. None of the patients were found to be homozygous. In the control group 11 (9.2%) were heterozygous carriers of factor V Leiden. The difference between the patients and the controls was not statistically significant. CONCLUSION: There was no clear association between RVO and factor V Leiden in this pool of patients. Factor V Leiden does not seem to play an important role in the development of RVO.

Ocular involvement in primary antiphospholipid syndrome. Ocular involvement in primary APS.

UNLABELLED: The purpose of this study is to evaluate the ocular findings in patients with the primary antiphospholipid syndrome (APS). PATIENTS AND METHODS: Twenty-two patients (44 eyes) with primary APS (17 women, 5 men) were examined. All patients were younger than 50 years (median age; 37.5 years). In 18 patients, fundus flourescein angiography was performed in addition to the ophthalmologic examination. RESULTS: Sixteen patients (72.7%) described visual symptoms. Anterior segment was normal in 19 patients (86.4%). Posterior segment abnormalities were observed in 15 patients (68.2%). Venous dilatation and tortuosity were the most common ocular findings. Retinal vascular occlusive disease was detected in 5 patients (22.7%). Flourescein angiography abnormalities were noted in 14 of the 18 patients (77.8%). The most common angiographic finding was pigment epithelial window defects. CONCLUSIONS: Our results indicate that posterior eye segment involvement is relatively common in the primary APS. It also seems that the screening for APS is important in young patients with retinal vascular occlusion, especially in those without conventional risk factors.

Silicone oil for recurrent vitreous hemorrhage in previously vitrectomized diabetic eyes.

AIMS: To investigate the clinical course of vitrectomized patients with recurrent diabetic vitreous hemorrhage who were treated by revitrectomy with silicone oil (SO) as a hemostyptic tamponade. PATIENTS AND METHODS: Fifteen patients with recurrent vitreous hemorrhage due to proliferative diabetic vitreoretinopathy were included in this retrospective study. All eyes had had at least one vitrectomy prior to use of SO and the retina was completely attached at any time before revitrectomy with SO instillation. Thirteen patients had a blind fellow eye. There were 6 males and 9 females (mean age 62.7 years, range 45-76 years). The mean duration of SO tamponade was 25.8 months (range 9-35 months). The average follow-up period was 30.4 months (range 20-48 months). RESULTS: Ten out of 15 eyes (66.6%) improved postoperatively, 9 eyes had a visual acuity of > or = 0.02 at the latest follow-up visit. Secondary glaucoma occurred in 4 eyes, leading to phthisis in 1 eye. All 5 phakic eyes developed a cataract. CONCLUSION: A revitrectomy combined with a long-term hemostyptic SO tamponade offers a chance for restoration of useful visual acuity in diabetic eyes with persistent vitreous-hemorrhage that fails to subside after cryocoagulation and vitrectomy without tamponade. Because of possible visual loss from secondary glaucoma related to intraocular SO this treatment should mainly be considered in patients with a blind fellow eye.

Alteration of visual function in impaired glucose tolerance.

People with impaired glucose tolerance are considered to be prone to diabetes. To evaluate their visual function we investigated colour vision with the Farnsworth-Munsell 100 Hue test and contrast sensitivity with Arden's grating cards in people with imparied glucose tolerance (IGT), people with normal glucose tolerance (NGT) and others with type II diabetes (NIDDM). Eyes with low vision or any anterior or posterior segment abnormalities were excluded. Contrast sensitivity and color vision differed significantly between the groups (p < 0.01). It thus appears that patients with IGT but without clinical diabetes could be followed up to see whether these alterations have any predictive value for the development of diabetes and diabetic retinopathy.