Early Ophthalmologic Examination Research Articles

CAN RIGID GAS PERMEABLE (RGP) CONTACT LENS BE THE BEST OPTION FOR A KERATOCONUS PATIENT?

Introduction : Keratoconus is a condition of cone-shaped cornea caused by stromal thinning. This disorder leads to visual disturbance due to irregular astigmatism, myopia, and corneal protrusion. A severe irregular astigmatism must be corrected by rigid gas permeable (RGP) contact lenses.
 Case Illustration : A 29 y.o female visited Ophthalmologist Clinic Subdivision of Refraction, Contact Lens, and Low Vision in RSKMM Provinsi Sumsel, complaining of discomfort while using her current glasses. Anamnesis, physical examination, and ophthalmologic examination were carried out. The patient then was maximally corrected of her refractive status, followed by contact lenses fitting and post- fitting evaluation.
 Discussion : Early ophthalmologic examination showed visual acuity of 6/60 ph 6/9 on both eyes. Corneal topography evaluation confirmed pattern of bilateral keratoconus, each 78% on right eye and 87% of left eye. Best-corrected visual acuity was 6/6 using S-3.50 C-7.00 180? (right eye) and S-4.00 C-6.00 170? (left eye). RGP fitting test was carried with trial lenses of S-4.00 D for both eyes with both base curve of 7.2 mm and diameter of 9.2 mm. Over-refraction showed result of S-3.50 D (right eye) and S-3.75 D (left eye) for both eyes to reach visual acuity of 6/6 and for patient to feel comfortable.
 Conclusion : While some period of adaptation was needed, severe keratoconus should be treated using RGP contact lenses to achieve a better prognosis. Accurate fitting test of RGP resulting in comfortable and satisfied outcome of patient.

An analytical study on the ocular manifestations of autoimmune blistering skin disorders, in patients attending a tertiary care hospital

Autoimmune blistering skin diseases are a heterogeneous group of diseases that have as their common feature autoantibodies directed against desmosomal structural proteins. They can sometimes affect the eye, with manifestations ranging from mild to potentially vision threatening. To evaluate the spectrum and incidence of ocular manifestations and to analyze whether early ophthalmological examination will be beneficial in reducing ocular morbidity.rn Hospital based analytical study conducted at Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu. This study involved 100 patients diagnosed with autoimmune blistering skin disorder attending Dermatology and Ophthalmology outpatient department and included a comprehensive ocular examination of the patients. The collected data were analysed with IBM.SPSS statistics software 23.0 Version. To find the association of significance in categorical data the Chi-Square test was used. In the above statistical tool, the probability value .05 was considered as significant level. Autoimmune blistering skin diseases were associated with a significant proportion of ocular manifestations, of which in this study, dry eye and conjunctivitis were the most common. Dry eye and conjunctivitis were the most common ocular manifestations in this study. Though none of the patients had vision threatening manifestations, a comprehensive ocular examination and follow up of these patients is necessary.

Geographic Variation in Strabismus Pattern Among Pediatric Age Group in Lebanon: A Single-Centre Five-Year Observational Study.

Background: Strabismus means ocular misalignment. It is also one of the most prevalent types of amblyopia and the leading cause of pediatric visual impairment.Objective: This study aims to determine the frequency of different types of strabismus and the associated refractive errors and amblyopia in patients younger than 16 years of age. This study also aims to compare the age at presentation and gender between the geographic locations and between different strabismus types.Materials and methods: A cross-sectional retrospective study was done using the archives of Beirut Eye and ENT specialist hospital between January 2014 and December 2018. Lebanese pediatric patients aged <16 years having strabismus were included in this study.Results: There was a total of 787 pediatric patients with strabismus, 62.6% of cases had esotropia (ET) and 30.2% exotropia (XT), with ET/XT: 2.07/1. Mt Lebanon had the highest number of cases, whereas Nabatieh was the only governorate with reversed ET/XT ratio. Most patients were diagnosed at the age of 1-5 years, with ET being the most common diagnosis, while XT was mostly found in patients aged 11-15. Hyperopia was the most common (55.4%) refractive error detected in our cohort of strabismus patients, followed by myopia and simple astigmatism. Amblyopia was found in 18.9% of cases, where Nabatieh had the highest count.Conclusion: Strabismus pattern was investigated for the first time across Lebanon to shed the light on the crucial role of early ophthalmologic examination, to detect early refractive error and strabismus, and to prevent amblyopia.

High Risk of Early Cataracts in Young Type 1 Diabetes Group: A Nationwide Cohort Study.

Background Chronic hyperglycemia in type 1 diabetes (T1D) patients results in ocular problems over time, but only a few studies emphasized on cataracts. Aim To evaluate the epidemiology of cataracts in the T1D population. Method A two-part study was conducted using data from the National Health Insurance Research Database in Taiwan. Information from the Longitudinal Health Insurance Database (LHID) was served as a template of the general population. In the first part, a total of 3,622 T1D cases registered between 1998 and 2007 were enrolled and compared with a matched group from the LHID. For identifying risk factors of cataracts in the T1D population in the second part, a total of 9032 T1D cases registered between 1998 and 2013 were included. Result Compared to the LHID, the hazard ratio (HR) of cataracts in the T1D group was 5.81 (95% CI 4.60–7.33), and the HR was higher in females (6.29, 95% CI 4.63–8.55). The peak incidence of cataracts occurred between age 20 and 29 in the T1D group, while in the LHID, it was after 60. The overall incidence of cataracts in the T1D group was 9.1%. In T1D patients with cataracts, they were found with higher rates of associated diabetic complications. Conclusion Compared to the nondiabetic population, cataracts seemed more rampant and premature in T1D patients, especially those of female gender. Early ophthalmologic examination should be considered in T1D patients.

Clinical treatment of traumatic optic neuropathy in children: Summary of 29 cases.

Clinical features and treatments for traumatic optic neuropathy (TON) in children are reported. Twenty-nine children were enrolled in the Affiliated Hospital of Qingdao University from April 1999 to May 2015 for retrospective analysis. Of these 29 patients, 5 received drug therapy, and 24 received drug therapy combined with surgical therapy. Among the patients who received surgical therapy, 23 received nasal endoscopic optic decompression under general anaesthesia, and 1 received nasal endoscopic orbital decompression under general anaesthesia. All the patients were followed up for at least 6 months. In 29 cases, 48.28% (14/29) had visual improvement. Of the 5 patients who received drug therapy, 3 showed improvement (60%). Of the 24 cases who received drug and surgical therapy, 11 showed improvement (45.83%). Of the 22 patients who lost visual sensitivity, 10 showed improvement (45.45%). Of the 7 cases with visual acuity above basic light sensitivity, 4 showed improvement (57.14%). In conclusion, TON in children can lead to poor diagnosis and prognosis because of the difficulty of examining children and their limited language expression ability. Early ophthalmologic examination is therefore essential for children with craniofacial injuries, and proper treatment should be undertaken as soon as possible.

Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study

ABSTRACT Introduction The middle third of the face is the most common site of injury and is frequently complicated by associated ocular injuries. It may be simple laceration, ecchymosis, circumorbital edema, or severe as globe injury or injury to the optic nerve and vision loss. Even severe injury like internal bleeding causes increased intraocular pressure and damages the optic nerve; if managed earlier, it could prevent further damage and dysfunction of the eye. Midfacial fractures associated with ocular injuries should have an early ophthalmological examination to detect ocular injuries. Little is known about the current epidemiology of midface fractures and associated ocular injuries in Tamil Nadu, the state of India. The aim was to study the etiology and pattern of middle third fracture and associated ocular injuries. Materials and methods This prospective study on midface fractures was carried out in the Department of Dentistry to analyze etiology, incidence, and patterns of midface fractures and associated ocular injuries. A total of 201 patients who reported with the history of midface injuries were included in the study. These patients were examined clinically and routine radiographs and computerized tomography magnetic resonance imaging (MRI) were taken to confirm the diagnosis. All the patients sustaining confirmed middle third fractures with or without eye signs were referred to an ophthalmology department for the evaluation and management of associated ophthalmic injury. Statistical Package for the Social Sciences software version 16.0 was used for data analysis. The outcome of the study was measured using percentages, mean, standard deviation, and test of proportion as appropriate. Results Traffic accident was the major cause of injury, mainly by motorized two wheelers (MTWs). Males in the 21 to 40 age group were common victims. Zygomatic complex fracture was the most common fracture type. Subconjunctival hemorrhage and infraorbital nerve injuries were common clinical findings. Conclusion Midthird facial injury cases should have an early ophthalmological examination for timely management to prevent dysfunction of the eye. How to cite this article Mohanavalli S, Suma E, Senthamarai G, Vijayabala GS. Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study. World J Dent 2016;7(3):135-140.

Analysis of facial injuries requiring ophthalmological care due to frontal vehicle collisions

Motor vehicle collisions are responsible for a large number of ocular injuries. Although ocular injuries require an early ophthalmological examination at the time of trauma to detect any type of ocular dysfunction, some ophthalmological abnormalities are not detected after the facial injury owing to failure of referral ophthalmologists. This study aimed to investigate the prevalence of requiring ophthalmological care by evaluating the patterns and severity of ocular and severe facial injuries from real-world vehicle collisions in Japan. We collected data on vehicle passengers with any facial injuries who were involved in frontal collisions. Data were obtained from in-depth data records from the Institute for Traffic Accident Research and Data Analysis (ITARDA), Japan from 1993 to 2005. Collision information and victims’ medical data were reviewed. The 226 victims had a mean age of 33.3 ± 14.9 years with an equivalent barrier speed of 35.2 ± 13.0 km/h. Thirty (13.3%) victims suffered ocular injury or fractures in the upper or middle face (OIFF). Victims with OIFF had a significantly higher severity of injuries, especially in the face and lower extremities, and suffered from a higher speed of collisions than those without OIFF (p&lt;0.001). Victims wearing seat belts had a significantly lower prevalence of having OIFF than those not wearing seat belts. Most of the victims with OIFF (29/30) were involved in collisions without deployment of airbags. To prevent severe ocular injuries, correct use of seat belts with airbag deployment is required. Additionally, the present study enhances that more victims with OIFF are cared for by ophthalmologists immediately after the collision, improving their quality of life and preventing conflicts owing to inadequate medical management.

Etiology, incidence and patterns of mid-face fractures and associated ocular injuries.

A prospective study on mid-face fractures was carried out in the Department of Oral and Maxillofacial Surgery at College of Dentistry, Indore, from August 2007 to September 2009 to analyze etiology, incidence and patterns of midface fractures and associated ocular injuries. Two hundred patients were included in this study, amongst those who reported to the Department of OMFS, College of Dentistry, Indore. After confirmed diagnosis of mid face fracture all the patients were stratified according to age, sex, cause of the accident, influence of alcohol, location, type of fractures and associated ocular injuries. The study included 200 patients with a mean age of 29.6years. The most frequently injured patients belonged to the 21-30year-old age group. The male predilection was 76%. Road traffic accident was the most common causative factor (64%), followed by assault (21%), cases of fall (9.5%) and other causes (5.5%). The most common fracture in this study was found to be zygomatic complex fractures (62.5%) (more in the age group of 21-30years). This was followed by Lefort II fractures (23%), multiple fractures (10%) and Lefort I fractures (6%), Lefort III fractures (4.5%) and Naso-ethmoidal fractures (4%) in descending order. 84.5% subjects were having ocular involvement. Subconjunctival hemorrhage was present mostly in 83.5% followed by remaining as corneal injury 15%, reduced acuity 11.5%, diplopia 10.5%, enophthalmos 8.5%, telecanthus 5%, hyphema 3.5%, blindness 3% and proptosis 0.5%. Zygomatic complex fractures were the most frequent type of injury that was complicated by blindness or a serious eye injury (61%). Collection of data regarding the epidemiology of maxillofacial fractures is important because it may assist healthcare providers to provide necessary information for the development and evaluation of preventive measures. Ocular injuries should have an early ophthalmological examination at the time of trauma to detect any kind of ocular dysfunction.

Medical Image Segmentation using the HSI color space and Fuzzy Mathematical Morphology

Diabetic retinopathy is the most common cause of blindness among the active population in developed countries. An early ophthalmologic examination followed by proper treatment can prevent blindness. The purpose of this work is develop an automated method for segmentation the vasculature in retinal images in order to assist the expert in the evolution of a specific treatment or in the diagnosis of a potential pathology. Since the HSI space has the ability to separate the intensity of the intrinsic color information, its use is recommended for the digital processing images when they are affected by lighting changes, characteristic of the images under study. By the application of color filters, is achieved artificially change the tone of blood vessels, to better distinguish them from the bottom. This technique, combined with the application of fuzzy mathematical morphology tools as the Top-Hat transformation, creates images of the retina, where vascular branches are markedly enhanced over the original. These images provide the visualization of blood vessels by the specialist.

Manifestações retinianas em pacientes portadores de anemia de células falciformes

The World Health Organization counts that more than 5% of the world's population carry some type of hemoglobinopathy. Among them we find the sickle cell aneamia that presents its main harmful effect on the peripheral vasculature. In the retina, the falciform lesions have a well defined physiopathology and classification. To identify the retinal manifestations caused by the falciform aneamia in patients directed to the Bettina Ferro de Souza Hospital from the Hemocenter of the State of Para - HEMOPA, in the months of September through December of 2006. METHODS: Ophthalmologic examination was performed in the Department of Ophthalmology of the Bettina Ferro de Souza Hospital. and fifty patients with sickle cell aneamia (SS or SC) followed by the department of falciform aneamia of the Hematologia e Hemoterapia do Para - HEMOPA have been randomly selected and submitted to interview in order to register their: sex; age; color; genotype; ocular alterations; medicines taken. Ophthalmologic examination was performed in the Department of Ophthalmology of the Bettina Ferro de Souza Hospital. It consisted of: evaluation of the acuity of vision with and without correction, indirect biomicroscopy, indirect binocular ophthalmoscopy, and, in case the latter presented alterations, a complementary study with angiofluoresceinography would be carried through. RESULTS: The outcomes have been registered in research protocol and later submitted to the statistic analysis using the Qui-square test, adopting, as level of significance, p<0,05. Eighty-eight percent of the patients did not present any falciform retinal sign, 3% presented peripheral vascular occlusion; in 2%, pigmented plate was shown, and 7% presented injuries which were not compatible with the falciform disease; there was a proportionality of 50% for males and females; there was a higher predominance (38%) of people aged from 11 and 15; 74% had SS genotype and 26% SC genotype; in relation to the use of medicines there was a higher prevalence of ocular alterations in patients who had made use of the folic acid isolated, with 5%, in contrast with those who had used the hidroxyurea association and folic acid, when all (27%) presented normal fundoscopic examination; all the patients (29%) that showed fetal hemoglobin rate above 10% had retina without alterations. CONCLUSION: Few cases of retinal signs have been observed in the studied group, however this research does not diminish the importance of early and periodic ophthalmologic examination, since falciform retinopathy is largely registered and its complications can lead to amaurosis.

Mycophenolate mofetil-induced pseudotumor cerebri in a boy with autoimmune lymphoproliferative disease

Pseudotumor cerebri (PTC) is a syndrome characterized with increased intracranial pressure, normal cerebrospinal fluid content (CSF), and a normal brain on imaging studies. In this case report, PTC has been linked to mycophenolate mofetil (MMF) that has been used for autoimmune lymphoproliferative syndrome (ALPS). A 5-year-old boy, who was using MMF for 4 months because of the ALPS, suffered from occipital headache and vomiting with no other symptom. The initial physical examination was normal expect bilateral papilledema. The patient underwent a lumbar puncture which showed elevated opening pressure (590 mmH₂O) but no laboratory abnormalities of the CSF. A diagnosis of PTC was established. MMF was stopped, and the child was started on an acetazolamide treatment for 2 weeks. His symptoms and complaints recovered after this treatment. According to our knowledge, we report the first case of MMF-induced PTC in a boy with ALPS. This case illustrates that despite the rarity of MMF-induced PTC, the physicians should be aware of this possibility. Furthermore, in the setting of new-onset headaches or visual changes, early ophthalmologic examination for papilledema is recommended for early diagnosis.

Congenital Toxoplasmosis in Southeastern Brazil: Results of Early Ophthalmologic Examination of a Large Cohort of Neonates

To report results of early ophthalmologic examinations in a large cohort of newborns with congenital toxoplasmosis (CT) after neonatal screening. Cross-sectional analysis of a cohort. A total of 178 newborns with confirmed CT from 146,307 screened babies (95% of live births) from Minas Gerais state, southeastern Brazil. From November 2006 to May 2007, newborns underwent neonatal screening by immunoglobulin (Ig)M capture of dried blood samples. On all positive or suspected cases, confirmative serology was performed on babies and their mothers. Congenital toxoplasmosis was confirmed in newborns who had IgM and/or IgA and IgG, or IgG associated with suggestive ocular lesions (with IgM and IgG in the mother). Ophthalmologic evaluation consisted of indirect ophthalmoscopy with a lid speculum. Pediatric examination and radiologic studies of the central nervous system were also performed. In selected cases, biomicroscopy of the anterior segment, fundus photographs, or ultrasonography (B-scan) was performed. Prevalence of retinochoroidal lesions, either cicatricial or active, and their location and associated findings, such as vascular sheathing, hemorrhage, vitreous opacities, and retinal detachment, were evaluated. The occurrence of cataract, microphthalmia, microcephaly, intracranial calcification, and hydrocephalus was also recorded. Of 146,307 neonates screened, 190 had CT, yielding a prevalence of 1 in 770 live births, of whom 178 (93.7%) underwent standardized ophthalmologic examination at an average age of 55.6+/-16.6 days. Of these 178 infants, 142 (79.8%) had retinochoroidal lesions consistent with CT in at least 1 eye. Bilateral involvement was noted in 113 patients (63.5%). Macular involvement was seen in 165 eyes (46.3%) of 111 patients (62.4%). Active lesions were observed in 142 eyes (39.9%) of 85 patients (47.8%). These lesions were located in the macula of 75 eyes (21.1%) and were associated with retinal vascular sheathing in 44 eyes (12.4%). A high prevalence of CT was encountered (1/770) with high rates of early retinochoroidal involvement ( approximately 80%) and many active lesions (in approximately 50%), indicating a possibly more severe ocular involvement by CT in Brazil than in other parts of the world. The hypotheses of higher parasite virulence and increased individual susceptibility are being currently investigated.

Doxycycline-Induced Pseudotumor Cerebri

Tetracyclines are a commonly prescribed medication for the treatment of acne vulgaris that are associated with pseudotumor cerebri (PTC). With doxycycline specifically, however, the incidence of PTC is very rare. A patient was using oral doxycycline and topical retinoids for acne, and within two months she developed PTC. This case illustrates that despite the rarity of doxycycline-induced PTC, patients and physicians should be aware of this possibility. Furthermore, in the setting of new-onset headaches or visual changes, early ophthalmologic examination for papilledema is recommended for early diagnosis.

FLUORESCEIN AND INDOCYANINE GREEN ANGIOGRAPHIES IN SUSAC SYNDROME

Susac syndrome is a rare microangiopathy of the brain, retina, and cochlea that mainly affects young women. We studied the management of this disease using retinal fluorescein and indocyanine green angiographies. Retrospective, observational case series of seven patients with Susac syndrome identified in ophthalmology and internal medicine departments. We reviewed medical, ophthalmologic, and angiographic records at study enrollment and during long-term treatment. Mean follow-up was 37 months. Best-corrected visual acuity, intraocular inflammation score, ophthalmoscopy data, automated perimetry score, and fluorescein and indocyanine green angiographic features were analyzed with the results of cerebral magnetic resonance imaging and spinal fluid analysis and ENT signs. Retinal fluorescein angiography showed focal nonperfused retinal arterioles with hyperfluorescent walls in all cases. Indocyanine green angiography showed normal choroidal circulation. Retinal vasculitis was uncontrolled in a patient treated with steroids. Improvement of retinal arteriole perfusion occurred during immunosuppressive treatment with cyclophosphamide. Absence of intraocular inflammation and focal, labile nonperfused retinal arterioles with integrity of choroidal circulation are monomorphic ophthalmologic features that could immediately suggest the diagnosis of Susac syndrome. Early ophthalmologic examination aided by retinal fluorescein angiography could be useful for managing cases of unexplained neurologic symptoms in women.

Ocular findings in individuals with intellectual disability

Background: The purpose of the study was to assess refractive errors and ocular abnormalities in intellectually disabled (ID) children and adults. Methods: In this study, a random sample of 180 participants with ages ranging from 9 to 50 were recruited and examined between January and April 2006. Refractive errors were measured by photorefractometer. The ophthalmologic examination consisted of a structural observation of the external eye, anterior and posterior segment evaluation, and examinations for strabismus. Results: A refractive error was the leading ocular diagnosis, found in 56 of 166 patients. Strabismus was the second most frequent ocular abnormality. Eyelid abnormalities were detected in 30 patients. Cataract was the fourth most frequent ocular pathology and also most frequent intraocular one. Overall, 28 patients (16.9%) had anterior segment findings, of whom 18 had congenital lens opacity. Posterior segment findings were detected in 23 of 166 patients. Interpretation: Ocular problems are common in ID individuals and are frequently correctable. We suggest that professionals provide early ophthalmologic examination and regular follow-up of young ID individuals.This would ensure that the required treatment of possible ocular disorders is received and would improve quality of life and social accommodation in this population.

Achados fundoscópicos em crianças portadoras de anemia falciforme no estado do Rio Grande do Norte

Objetivos: Detectar os principais achados fundoscopicos em criancas portadoras de hemoglobinopatias falciformes. Metodos: Foram estudados 26 pacientes com hemoglobinopatias falciformes, no Servico de Oftalmologia do Hospital Universitario Onofre Lopes, Natal, RN, que foram submetidos a protocolo de pesquisa pre-estabelecido. Os resultados foram avaliados estatisticamente pelo teste qui-quadrado. Resultados: A idade media foi de 10,6 anos, com acuidade visual igual ou melhor que 20/25 na maioria, excetuando-se 3 olhos, que apresentavam outras doencas associadas. O tipo mais frequente foi o SS com 57,7% (15/26) dos casos, seguido pelos SC e SA com 15,4% (4/26) cada, e pelo S-Thal com 11,5% (3/26). A frequencia da retinopatia por celulas falciformes foi maior apos os 10 anos de idade, sendo mais frequente, em valores relativos, no tipo S-Thal (100% dos casos) e, em valores absolutos, no tipo SS (9 casos). Os dois achados mais comuns foram tortuosidade venosa (12/26) e black sunburst (7/26). Conclusoes: Observamos que a incidencia de retinopatia por celulas falciformes aumentou apos os 10 anos de idade e nao evidenciamos achados da doenca proliferativa. Portanto, enfatizamos a necessidade do exame oftalmologico precoce nos portadores de anemia falciforme, como forma de prevenir futuras complicacoes oculares.

Ocular Leukemia in King Abdulaziz University Hospital — Jeddah

To the best of our knowledge, ocular leukemia has not been reported in Saudi Arabia. Seventy-two leukemia patients were seen in King Abdulaziz University Hospital in Jeddah over the last 10 years. Thirty-one of those patients had an ocular examination. Seventeen of these were found to have ocular abnormalities related to leukemia. Ten had acute lymphoblastic leukemia, four had acute myeloid leukemia and three had chronic myeloid leukemia. The retina and vitreous were involved in 12 of the ocular relapses, the anterior segment leukemic infiltrate in nine, glaucoma in five, opportunistic infection in four, cranial nerve palsies in three, proptosis and hypotony in two. Conjunctival hemorrhage, choroidal infiltrate and cataract were present in one relapse each. The optic nerve was involved in nine relapses, which is a serious condition that requires immediate intervention to save the patient's sight. Computed tomography (CT) scan of the brain and orbit was useful in differentiating between optic nerve infiltrate and papilledema. Most ocular relapses responded well to chemotherapy except relapses with optic nerve and anterior segment infiltrate, which required irradiation to save the patient's sight and prevent further relapses. In conclusion, the presented data have shown that ocular leukemia is not rare and emphasizes the importance of early ophthalmologic examination and radiation.

Pneumocystis Carinii Choroiditis After Long-term Aerosolized Pentamidine Therapy

Pneumocystis carinii pneumonia is a major cause of morbidity and mortality in patients with the acquired immunodeficiency syndrome. When P. carinii is disseminated, the choroid may be involved and the infection is often fatal. We examined, treated, and followed up two patients who developed choroidal lesions typical of P. carinii while taking aerosolized pentamidine for prophylaxis. The choroidal lesions gradually resolved after three weeks of therapy with intravenous trimethoprim and sulfamethoxazole in one patient, and after three weeks of therapy with parenteral pentamidine in the other patient. The patients did not have clinical or laboratory evidence of P. carinii infection other than in the eye. It thus appears that early ophthalmologic examination may detect disease before it is threatening to sight and allow systemic therapy to be instituted before widely disseminated infection results in a fatal outcome

Pneumocystis Carinii Choroiditis After Long-Term Aerosolized Pentamidine Therapy

Pneumocystis carinii pneumonia is a major cause of morbidity and mortality in patients with the acquired immunodeficiency syndrome. When P. carinii is disseminated, the choroid may be involved and the infection is often fatal. We examined, treated, and followed up two patients who developed choroidal lesions typical of P. carinii while taking aerosolized pentamidine for prophylaxis. The choroidal lesions gradually resolved after three weeks of therapy with intravenous trimethoprim and sulfamethoxazole in one patient, and after three weeks of therapy with parenteral pentamidine in the other patient. The patients did not have clinical or laboratory evidence of P. carinii infection other than in the eye. It thus appears that early ophthalmologic examination may detect disease before it is threatening to sight and allow systemic therapy to be instituted before widely disseminated infection results in a fatal outcome.

Septicémie nosocomiale à Candida albicans au cours d'une alimentation parentérale sur veine périphérique

Fungal septicaemias during total parenteral nutrition are frequent, but their occurrence during parenteral nutrition via a peripheral vein is uncommon. A case of disseminated candidaemia with ocular and renal localizations during parenteral nutrition via a peripheral vein is reported in a 24 year old patient hospitalized for primary cerebellar haemorrhage. The case history showed the importance of early ophthalmologic examination in all septicaemic cases. The diagnosis was confirmed by nine positive blood cultures and immunological tests, but the dosage of soluble antigens remained negative. The part played by a contaminated perfusion bottle out-of-date was suggested, but could not be proved absolutely. The assessment of the immune state could wrongly suggest an acquired immunodeficiency syndrome, for it has been demonstrated that Candida albicans itself had an immunosuppressive activity.