Bilateral Retinitis Research Articles

Ophthalmoplegia associated with AIDS

A 34-year-old man with AIDS was admitted to the hospital with a one-week history of cough, chest pain, and fever. Radiography revealed a cavitating left upper lobe lesion. Two weeks later he developed a headache associated with a contrast enhancing lesion in the right parietal lobe. The patient had a progressive downhill course, developing atrioventricular block and hypernatremia. Neuro-ophthalmologically, there was a mild facial droop, “hand motions” vision with presumed bilateral cytomegalic inclusion retinitis, and signs of a mesencephalic syndrome, including lid retraction. Discussions center on the differential diagnosis of the central nervous system disease and the obligative recommendations the neuro-ophthalmologist must be willing to make.

Miliary Toxoplasmic Retinitis in Acquired Immunodeficiency Syndrome

A unique pattern of bilateral miliary retinitis due to ocular toxoplasmosis developed in a patient in the late stages of acquired immunodeficiency syndrome. Results of serologic tests for toxoplasmosis remained negative throughout the clinical course of his ocular disease. The retinitis was unresponsive to a brief course of anti-toxoplasmosis therapy. At autopsy, the histopathologic material was consistent with toxoplasmic retinitis and the DNA polymerase chain reaction was positive for toxoplasmosis. Recognition of this pattern of retinitis is important in the appropriate treatment of immunosuppressed patients with retinitis.

Werner's Syndrome: A Libyan Family with Nine Affected Members

Werner's Syndrome: A Libyan Family with Nine Affected Members

Extraretinal Cytomegalovirus Infection Following Retinal Reattachment Surgery in a Patient With Acquired Immunodeficiency Syndrome

Cytomegalovirus (CMV) retinitis is the most common opportunistic ocular infection of the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus antigens have been immunohistochemically localized in all layers of the retina, but are rarely found in ocular tissue other than the retina. 1,2 We recently cared for a patient with AIDS and CMV retinitis who developed endophthalmitis following a scleral buckling procedure. Cytomegalovirus was the only pathogen identified on histopathologic examination of the eye and was present in spindle cells and vascular endothelial cells of the organized vitreous. Report of a Case. —A 31-year-old man with AIDS was being treated with intravenous ganciclovir for bilateral CMV retinitis. The patient had been doing well for nearly 3 months, with visual acuities of 20/40 OD and 20/20 OS, when an area of retinal whitening and intraretinal hemorrhage developed in the periphery of the superior temporal retina of the right eye. The dosage of ganciclovir

Long-term Intravitreal Ganciclovir Therapy for Cytomegalovirus Retinopathy

The safety and efficacy of intravitreously administered ganciclovir sodium as sole treatment for cytomegalovirus retinitis complicating the acquired immunodeficiency syndrome was studied prospectively in seven patients. All but one of the patients had bilateral cytomegalovirus retinitis and none were able to tolerate therapy with systemically administered ganciclovir because of myelosuppression in six patients and hepatotoxicity in one patient. Intravitreal ganciclovir therapy was discontinued in two patients within the initial 2-week induction phase because of severe intractable thrombocytopenia in one patient and retinal detachment in the other. The retinal detachment could not be conclusively attributed to the injections and was probably a secondary complication of cytomegalovirus retinitis. The remaining five patients were treated weekly, with the course of therapy ranging from a minimum of 14 weeks (18 injections) to a maximum of 56 weeks (58 injections). The patients were followed up for an average of 23.5 weeks. All eyes responded to intravitreal therapy initially, while the six untreated control eyes with cytomegalovirus retinitis all demonstrated progression of disease. Two eyes relapsed while receiving intravitreal doses of 200 micrograms of ganciclovir sodium and were subsequently treated with 300 micrograms of ganciclovir sodium per injection. One eye responded to this regimen, while in the other one the disease progressed. In the long-term treatment group, one eye developed Staphylococcus epidermidis endophthalmitis, which was treated with vitrectomy and intravitreal and systemic antibiotics.

Cytomegalovirus Retinitis and Acquired Immunodeficiency Syndrome

In a series of 157 patients with acquired immunodeficiency syndrome (AIDS), 46 (29%) developed cytomegalovirus (CMV) retinitis. In five patients, CMV retinitis was the initial AIDS-defining opportunistic infection (11% of patients with CMV retinitis and 3% of patients with AIDS). Retinal detachments developed in seven patients (15%) and in four were present before the institution of ganciclovir therapy. Bilateral CMV retinitis was present in 35% of patients at presentation and subsequently developed in nine (60%) of 15 patients while not being treated with ganciclovir. Conversely, none of 18 patients with unilateral disease developed bilateral disease while receiving ganciclovir. Of patients treated with ganciclovir for their CMV retinitis, 81% had a response to the drug, and 61% achieved a complete response, resulting in a nonprogressive and inactive scar. Patients who achieved a complete response with ganciclovir had a significantly longer survival than those who did not, suggesting greater immune compromise in those patients who failed to respond to ganciclovir.

Use of Intravitreal Ganciclovir (Dihydroxy Propoxymethyl Guanine) for Cytomegalovirus Retinitis in a Patient With AIDS

A patient with acquired immune deficiency syndrome with bilateral cytomegalovirus retinitis was treated with intravitreal 200-micrograms/0.1-ml doses of ganciclovir (9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine). The ganciclovir serum and intravitreal concentrations were measured with an enzyme-linked immunosorbent assay and pharmacokinetic factors were determined. There was no evidence of systemic absorption of ganciclovir from the eye. The elimination half-life of ganciclovir from the vitreous was estimated to be 13.3 hours. The intravitreal concentration remained above the ID50 of cytomegalovirus for approximately 62 hours after a single injection. Clinically, the patient retained useful vision in his right eye for three months. A total of 28 intravitreal injections were given on an outpatient basis under topical anesthesia and were well tolerated. There was no evidence of retinal toxicity from the drug.

Effect of 9-(1,3-dihydroxy-2-propoxymethyl) guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men.

Eight immunosuppressed homosexual men with cytomegalovirus viremia--seven with serious bilateral retinitis, one with colitis in addition to retinitis, and one with pneumonitis only--were treated with a new acyclovir derivative, 9-(1,3-dihydroxy-2-propoxymethyl) guanine, which has excellent in-vitro activity against cytomegalovirus. All patients had virologic and clinical improvement, but substantial leukopenia developed in three patients. Both clinical relapses and viral relapses occurred frequently, usually within 30 days after cessation of treatment. 9-(1,3-Dihydroxy-2-propoxymethyl) guanine represents the first clinically and virologically effective agent for the treatment of cytomegalovirus disease, but more effective and less toxic therapeutic regimens for both acute and chronic use must be developed.

A case of retinitis pigmentosa associated with Coats’ syndrome

The association of bilateral retinitis pigmentosa with Coats' syndrome is reported. Four lesions of vascular telangiectasis with yellowish exudates were treated by xenon photocoagulation or cryocautery. Seven months later, new vascular changes occurred in another quadrant of the fundus. Since xenon photocoagulation could not be performed because of the patient's aversion to pain, argon laser photocoagulation was used but found ineffective. Cryocautery was necessary to treat the exudation over one quadrant, though xenon photocoagulation was effective in small lesions.

Herpes Simplex Type 1 Retinitis in an Adult with Systemic Herpes Zoster

A 72-year-old man developed bullous skin lesions two months before he was discovered to have malignant lymphoma. Herpes zoster virus grew from the skin bullae. He developed encephalitis, keratitis in the left eye, and bilateral retinitis 18 months later. Herpes simplex virus type 1 grew from cultures of the eyelid vesicles and corneal scrapings from the left eye. The patient died two years after the diagnosis of malignant lymphoma. Virus particles believed to be herpes simplex virus were demonstrated on electron microscopy in the necrotic retinal cells.

Rift Valley Fever Retinitis

A 57-year-old Dutch woman, who had lived and worked in Tanzania for 26 years, developed serious, progressive bilateral retinitis after suffering from a fever of unknown origin. Fundus abnormalities in both eyes suggested that the woman had been infected with Rift Valley fever virus. Serologic studies confirmed this suspicion. White macular lesions accompanied to extensive vasculitis appear to be specific for Rift Valley fever retinitis.

Temporal aspects of the electroretinogram in sector retinitis pigmentosa.

Temporal aspects of the electroretinogram (ERG) are studied in two patients with bilateral nasal sector retinitis pigmentosa and one patient with bilateral macular degeneration and pericentral retinitis pigmentosa that appeared sectorial in type. In these three patients with sector retinitis pigmentosa, the ERGs in response to full-field light stimuli are reduced in amplitude, but the cone and rod implicit times are normal. In contrast, patients with reduced ERG amplitudes and early stages of widespread recessive retinitis pigmentosa have cone and rod ERG implicit times that are delayed. The results indicate that implicit time and amplitude of ERG responses are independent criteria of retinal function in hereditary retinal degenerations. The temporal aspects of the ERG separate localized retinitis pigmentosa from other types of retinitis pigmentosa where the degeneration is widespread and, therefore, help to define the extent of retinal disease.

Cytomegalic inclusion retinitis in an adult.

Bilateral cytomegalovirus retinitis of four months' duration followed renal transplantation in an adult. The clinical appearance was documented by serial fundus photographs which were correlated histopathologically. The ultrastructural features are also presented.

A CASE OF BURNS ASSOCIATED WITH BILATERAL RETINITIS

Medical Journal of AustraliaVolume 1, Issue 18 p. 459-460 Reports of Cases A CASE OF BURNS ASSOCIATED WITH BILATERAL RETINITIS A. L. Newson, A. L. Newson Major Australian Army Medical CorpsSearch for more papers by this authorK. B. Armstrong, K. B. Armstrong Major Australian Army Medical CorpsSearch for more papers by this author A. L. Newson, A. L. Newson Major Australian Army Medical CorpsSearch for more papers by this authorK. B. Armstrong, K. B. Armstrong Major Australian Army Medical CorpsSearch for more papers by this author First published: 01 May 1945 https://doi.org/10.5694/j.1326-5377.1945.tb54855.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue18May 1945Pages 459-460 RelatedInformation