Histoplasma capsulatum endophthalmitis after cataract extraction.

A 60-year-old white man from an area endemic for Histoplasma capsulatum presented with a vitreous wick, hypopyon iritis, and dense vitreitis 2 months after removal of an anterior chamber intraocular lens (IOL) for chronic iritis. A diagnostic vitrectomy was performed and H. capsulatum was cultured and identified 2 weeks later. Despite intravitreal and intravenous amphotericin as well as repeat vitrectomies, the inflammation worsened and the eye was removed. Results of histopathologic examination showed Histoplasma organisms along the vitreous wick, over the surface of the iris and ciliary body, and over the retina. No organisms were found in the choroid. Dalen-Fuchs-type nodules similar to those of sarcoid also were noted, but there was no evidence of granulomatous inflammation in the uvea. Because of his unilateral disease with Histoplasma in the vitreous wick, negative serology, and an absence of systemic infection, the authors believe that this patient had a previously unreported form of ocular Histoplasma, exogenous postoperative Histoplasma endophthalmitis.

Early retinal adhesion from laser photocoagulation.

Histopathologic examination of eight cynomolgus monkey eyes and one human eye revealed that both argon and krypton laser photocoagulation cause adhesion between the neurosensory retina and the retinal pigment epithelium (RPE) within 24 hours of treatment. The neurosensory retina remained attached at the sites of laser burns despite surrounding retinal detachment in untreated areas. This early adhesion with the laser is useful for the treatment of eyes in which the retina has been recently reattached such as at the end of a vitrectomy for a retinal detachment with proliferative vitreoretinopathy (PVR) or after a pneumatic retinopexy. It is also useful for the treatment of retinal breaks without detachment.

The treatment of serous macular detachment secondary to choroidal melanomas and nevi.

The authors successfully treated with laser photocoagulation five patients who had a serous macular detachment secondary to leakage from a pigmented choroidal tumor. Three patients had dye leakage on fluorescein angiography from a choroidal neovascular membrane. The subretinal fluid resolved in all three patients after the neovascular membrane was obliterated by either krypton red (2 patients) or argon green (1 patient) laser photocoagulation. The other two patients had prominent leakage from a localized choroidal neovascular membrane as well as mild diffuse leakage over the entire tumor. Focal argon laser treatment to the neovascular membrane alone did not cause permanent resolution of the subretinal fluid. The fluid did resolve, however, after the entire area of diffuse leakage was retreated with photocoagulation. In one of the patients who received both focal and confluent laser treatment, the choroidal tumor grew in a collar-button fashion through Bruch's membrane at the original site of focal treatment. This eye was enucleated, and results of histopathologic examination showed a choroidal melanoma.

Results and complications of pneumatic retinopexy.

Fifty-one patients with primary rhegmatogenous retinal detachment (RD) were treated by pneumatic retinopexy. The overall success rate for reattachment with one operation was 63%. Of the 34 phakic eyes, 25 (74%) were reattached; of the 17 aphakic or pseudophakic eyes, seven (41%) were reattached (P less than 0.05). Postoperative complications included the development of new tears (22%), inadequate closure of the original tear, shifting and delayed absorption of subretinal fluid, and opening of previously closed tears. Pneumatic retinopexy is a valuable new technique; however, careful patient selection and postoperative management is required.

The treatment of diabetic retinopathy.

Advances in our understanding of diabetic retinopathy have allowed the development of new treatments directed at the preservation of sight. This paper reviews the various clinical stages of this disorder with an emphasis on the underlying pathophysiologic mechanisms. A rational approach to the management of this disorder based upon pathogenesis is then presented.

The incidence of retinal detachment following extracapsular cataract extraction. A ten-year study.

A long-term prospective study was conducted to evaluate the incidence of specific complications following extracapsular cataract extraction. Eight hundred forty-two consecutive extracapsular cataract extractions were performed over a ten-year period with a minimum follow-up time of one year. The mean follow up period for this series was 32.2 months. The incidence of retinal detachment in the entire population was 1.4%. In those eyes with a cataract as the only ocular abnormality and with no surgical complications, the frequency was 1.0%. The incidence in eyes following uncomplicated procedures, with no other ocular pathology and with an intact posterior capsule was 0.8%. The incidence of opacification of the posterior capsule requiring capsulotomy was 16.7%. The mean time interval for a secondary capsulotomy was 24.3 months. A positive correlation between this time interval and patient age was established.

Incidence of retinal detachments following extracapsular cataract extractions. A prospective study.

This is a preliminary report on a prospective study designed to determine the incidence of retinal detachment following planned extracapsular cataract extractions. The population consists of 454 eyes with a mean follow-up period of 23 months. The incidence of detachment is much lower than that reported for intracapsular extractions. The most significant finding to date is the importance of maintaining the posterior capsule and the vitreous face intact. The incidence of detachment when this is accomplished in normal eyes is 0.9%. The overall incidence of this complication in the entire series is 1.50%. The reported disadvantage of maintaining the posterior capsule is the 40% to 50% incidence of a secondary cataract. In this series, the incidence is 11%. The factors responsible for this low figure are enumerated.