1/98. Upward extension of an atrophic tract of the retinal pigment epithelium associated with congenital macular toxoplasmosis.PURPOSE: To report an unusual case of gravitational atrophic tract of the retinal pigment epithelium in a 20-year old woman. methods: Case Report. RESULTS: The patient had macular cicatricial congenital toxoplasmic chorioretinitis in both eyes. In the right eye, an atrophic tract of the retinal pigment epithelium originating from the upper margin of the macular scar extended upwards toward the retinal periphery. CONCLUSION: The unusual upward direction of the atrophic tract of retinal pigment epithelium may be explained by the in utero head position during the active phase of the chorioretinal disease.- - - - - - - - - - ranking = 1keywords = retinitis (Clic here for more details about this article) |
2/98. The 22-kDa antigen in optic nerve and retinal diseases.OBJECTIVE: patients with unexplained visual loss were evaluated for the possibility of immunologic involvement. Antibody reactions were sought that might identify a common indication of retinal hypersensitivity. methods: The enzyme-linked immunosorbent assay (ELISA) and Western blot analysis were used to identify autoantibody reactions with retina and optic nerve components. Comparisons were made with the autoantibody reaction of normal subjects and patients with recognized forms of retinal decay: macular degeneration, retinitis pigmentosa, diabetic retinopathy, and paraneoplastic retinopathy. RESULTS: Eight patients, one man and seven women, were found to produce an autoantibody reaction with retina and optic nerve, including a novel 22-kDa neuronal antigen present within the retina and optic nerve. One of the eight had retinopathy associated with melanoma (MAR Syndrome). Seven of the eight patients had electroretinogram abnormalities, varying from mild to severe. Six displayed features of optic atrophy. One patient with progressive visual loss had visual function stabilized after immunosuppressive therapy. CONCLUSIONS: In the eight cases described, unexplained visual loss was associated with autoantibody reactions with retina and optic nerve, including a common antibody reaction with a 22-kDa neuronal antigen found in the retina and optic nerve. All the patients had either an abnormal electroretinogram or optic atrophy. Six patients had both. The 22-kDa immunologic marker may not be directly involved in the patient's vision loss, but rather may be related to a nonspecific destruction of retina and optic nerve. However, the marker may be useful in identifying a specific subgroup of patients for further analysis.- - - - - - - - - - ranking = 1keywords = retinitis (Clic here for more details about this article) |
3/98. central serous chorioretinopathy and hiv.BACKGROUND: patients with central serous chorioretinopathy (CSC) have sudden-onset, painless, uniocular blur that is typically diagnosed via fundus and fluorescein angiographic appearance. The etiology and pathophysiology are not fully understood; however, there may be an association with an infectious etiology. This article presents two cases of hiv-positive patients in whom central serous chorioretinopathy developed and discusses the possible relationship between the two cases. The differential diagnosis, clinical features, angiographic appearance, management options, and proposed etiologies of CSC will be presented. case reports: A 34-year-old black man hiv reported to the eye clinic with decreased vision in his right eye. A diagnosis of central serous chorioretinopathy (CSC) was made on the basis of the clinical and fluorescein appearance. He is currently being monitored for resolution. A 44-year-old black man with profoundly compromised immunity also came to the eye clinic with CSC and hiv retinopathy. He later progressed to CMV retinitis and subsequently died. CONCLUSION: Although considered in many cases to be idiopathic, central serous chorioretinopathy has been associated with infectious etiologies, one of which could be hiv.- - - - - - - - - - ranking = 1keywords = retinitis (Clic here for more details about this article) |
4/98. Progressive confluent circumpapillary multiple evanescent white-dot syndrome.PURPOSE: To describe a morphologic variant of the multiple evanescent white-dot syndrome that can mimic other conditions. methods: We examined three patients with severe cases of unilateral multiple evanescent white-dot syndrome characterized by an atypical progressive circumpapillary discoloration of the fundus. RESULTS: The confluent circumpapillary lesion progressed toward or beyond the equator of the fundus, raising initial concern of a viral retinitis. However, pinpoint dots at the leading edge evolved into the typical wreath-like spots of multiple evanescent white-dot syndrome, which then coalesced into the advancing edge of a geographic retinitis or retinal pigment epitheliitis, before spontaneous resolution. CONCLUSION: Progressive geographic circumpapillary discoloration, appearing as a giant white spot, occurs rarely in severe cases of multiple evanescent white-dot syndrome. The distinctive appearance may suggest a disorder other than multiple evanescent white-dot syndrome, which can make initial diagnosis more difficult and lead to unnecessary or inappropriate testing and treatment.- - - - - - - - - - ranking = 2keywords = retinitis (Clic here for more details about this article) |
5/98. Fundus albipunctatus and other flecked retina syndromes.BACKGROUND: Several ophthalmic conditions manifest a flecked retina. Developing an understanding of their clinical presentations will enable the practitioner to most appropriately manage these conditions. CASE REPORT: A 27-year-old Middle Eastern woman manifested flecked retinas and nyctalopia. She had been given a diagnosis of retinitis punctata albescens, an inherited, progressive, night blindness; however, the medical history and clinical findings were not consistent with this disorder. Rather, they were consistent with fundus albipunctatus, an autosomal recessive, stationary, night blindness. The clinical presentation of fundus albipunctatus is characterized by discrete, white dots at the level of the retinal pigment epithelium and stable night blindness. A prolonged time for dark adaptation is required to produce normal amplitude electroretinograms in fundus albipunctatus as the result of a delay in the regeneration of rhodopsin. An electroretinogram administered after a prolonged dark adaptation time confirmed the diagnosis of stationary night blindness. CONCLUSION: In order to ensure an accurate diagnosis for fundus albipunctatus, it is important to be aware of the clinical characteristics and appropriate electroretinogram protocol for this disorder.- - - - - - - - - - ranking = 1keywords = retinitis (Clic here for more details about this article) |
6/98. Bilateral frosted branch angiitis and cytomegalovirus retinitis in acquired immunodeficiency syndrome.This report describes a case of frosted branch angiitis associated with AIDS.- - - - - - - - - - ranking = 21.454408313029keywords = cytomegalovirus retinitis, retinitis, cytomegalovirus (Clic here for more details about this article) |
7/98. Reversible bull's-eye maculopathy associated with intravitreal fomivirsen therapy for cytomegalovirus retinitis.PURPOSE: To report two cases in which a bull's eye maculopathy developed after intravitreal injection of fomivirsen. methods: case reports. RESULTS: A 50-year-old man with acquired immunodeficiency syndrome (AIDS) and refractory cytomegalovirus retinitis developed bull's-eye pigmentary changes in the macula of the right eye after initiating therapy with fomivirsen (Vitravene; CIBA Vision, Atlanta, georgia) intravitreal injections. These pigmentary changes resolved upon cessation of treatment. A 36-year-old man with AIDS and refractory bilateral cytomegalovirus retinitis developed bull's-eye pigmentary changes in both eyes during bilateral intravitreal treatment with fomivirsen. Vision was not affected. These changes resolved after treatment with fomivirsen was stopped. CONCLUSION: Fomivirsen, a new medication for the treatment of refractory cytomegalovirus retinitis, may cause a bull's-eye maculopathy in some patients. The bull's-eye maculopathy is reversible and does not appear to affect vision.- - - - - - - - - - ranking = 37.5452145478keywords = cytomegalovirus retinitis, retinitis, cytomegalovirus (Clic here for more details about this article) |
8/98. Multiple arterial ectasias in patients with sarcoidosis and uveitis.PURPOSE: To describe and evaluate the cause of a clinical entity characterized by bilateral intraocular inflammation, multiple arterial ectasias including beading, macroaneurysms, comma-like ectasias and kinking, with vasculitis, staining of the optic disk and multiple peripheral round punched-out hypopigmented chorioretinal scars in elderly patients. The formation and the course of the arterial ectasias is analyzed. methods: Seven patients with this syndrome were evaluated by clinical examination, fluorescein angiography, and systemic investigations. RESULTS: Three of the seven patients had a biopsy characteristic of sarcoidosis, two others showed positive bronchoalveolar lavage, as well as other analyses and tests suggesting sarcoidosis, and two showed other findings suggestive of sarcoidosis. The patients were all over 60 years of age and had arterial hypertension. In two patients, an arterial ectasia developed at the site of previous focal inflammation. The macroaneurysms either remained unchanged, became comma-like ectasias, arterial kinks, or completely vanished. CONCLUSION: Elderly patients with multiple arterial ectasias, uveitis, disk staining, and peripheral chorioretinitis should be thoroughly investigated for sarcoidosis. We suggest that sarcoidosis may cause some degree of arteritis, which may weaken the arterial wall, with resulting ectasia. Arterial hypertension may play a role in the formation of the ectasias by increasing the pressure on the arterial wall weakened by inflammation.- - - - - - - - - - ranking = 1keywords = retinitis (Clic here for more details about this article) |
9/98. Frosted branch angiitis in a child with hiv infection.PURPOSE: In adults with human immunodeficiency virus (hiv) infection, frosted branch angiitis is commonly associated with cytomegalovirus retinitis and responds to anti-cytomegalovirus therapy. We describe the first pediatric case of hiv-associated frosted branch angiitis. methods: Case report. RESULTS: A 7-year-old hiv-infected male with frosted branch angiitis was refractory to induction doses of intravenous ganciclovir and foscarnet over a 2-month period. Although cytomegalovirus antigenemia resolved, the angiitis only improved after subsequent treatment with systemic corticosteroids. CONCLUSION: Frosted branch angiitis in this patient was not attributed to cytomegalovirus. The pathogenesis of hiv-associated frosted branch angiitis may differ between children and adults.- - - - - - - - - - ranking = 5.5891374521575keywords = cytomegalovirus retinitis, retinitis, cytomegalovirus (Clic here for more details about this article) |
10/98. Ischemic maculopathy in patients with acquired immunodeficiency syndrome.PURPOSE: To describe the characteristics of ischemic maculopathy in patients with human immunodeficiency virus (hiv) infection, as a means of understanding this uncommon disorder more fully. methods: This is a multicenter, retrospective review of clinical data available for five hiv-infected patients who were given the diagnosis of ischemic maculopathy. RESULTS: All cases had been diagnosed on the basis of fluorescein angiograms obtained after patients complained of vision loss. Four of the five patients had bilateral macular disease. visual acuity at presentation in the nine affected eyes ranged from 20/20 to count fingers. Vision loss was gradual in both eyes of one patient and was abrupt in onset in seven eyes. Each of the seven eyes with abrupt vision loss had opacification of the superficial retina and/or intraretinal hemorrhages near the fovea. fluorescein angiography revealed enlargement of the foveal avascular zone and mild staining of the juxtafoveal vessels in affected eyes. Six eyes had active or clinically inactive cytomegalovirus retinitis at presentation, and a seventh eye developed cytomegalovirus retinitis 2 weeks later. All patients were receiving anticytomegalovirus drugs when they developed visual symptoms. visual acuity remained stable in five eyes, became worse in two eyes, and improved in two eyes; final visual acuity ranged from 20/25 to count fingers. CONCLUSIONS: Ischemic maculopathy may cause profound and permanent vision loss in hiv-infected individuals. fluorescein angiography should be considered in all hiv-infected patients with unexplained loss of vision. The pathogenesis of ischemic maculopathy remains unknown.- - - - - - - - - - ranking = 10.802382614481keywords = cytomegalovirus retinitis, retinitis, cytomegalovirus (Clic here for more details about this article) |
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