Uveal metastatic carcinoma in human immunodeficiency virus infection.

We report the occurrence of uveal metastatic carcinoma in two patients with longstanding HIV infection presenting with decreased visual acuity. In the first case, a 49-year-old man with a 6-year history of HIV infection presented with a 4-5 month history of blurred vision in his right eye. In the second case, a 53-year-old man with a 5-year history of HIV infection presented with a 3-week history of distorted and blurred vision in both eyes. In both cases, a choroidal metastatic carcinoma was ultimately discovered. To our knowledge, these are the first reported cases of metastatic uveal carcinoma in individuals with HIV infection. Currently, there have been dramatic improvements in treatment for HIV infection and longer survival times of infected individuals. This fact, together with reported increased frequencies and aggressiveness of carcinomas in HIV-infected individuals will likely result in increasing occurrences of uveal metastases from primary carcinomas in HIV.

Subretinal exudative deposits in central serous chorioretinopathy.

The presence of subretinal exudation in a patient with neurosensory detachment of the macula frequently suggests the diagnosis of choroidal neovascularisation. A retrospective chart review of newly diagnosed cases of central serous chorioretinopathy revealed 11 patients, seven men and four non-pregnant women, who had plaques of subretinal exudate, which presumably were fibrin. Each of these patients had a solitary plaque that ranged in size from 300 to 1500 microns in diameter. These patients had no signs or a clinical course suggestive of choroidal neovascularisation. In each case the subretinal plaque was overlying an exuberant leak in the retinal pigment epithelium. The exudate was generally present at the initial examination, and usually showed dissolution before or coincident with the resolution of the neurosensory detachment. After resolution of the central serous chorioretinopathy, patients were left with subtle alterations in the retinal pigment epithelium in the areas of the subretinal plaque. These findings are important for two reasons. Firstly, the presence of subretinal exudation does not necessarily rule out the diagnosis of central serous chorioretinopathy. Secondly, pathophysiological theories of central serous chorioretinopathy must explain how the plaques are deposited behind the retina.

Transient posterior subcapsular lens opacities in diabetes mellitus.

In three patients with transient cataracts the lenticular opacities were feathery in nature, and posterior subcapsular in location. They appeared to emanate from a dense central posterior subcapsular plaque. These opacities were examined with the slit lamp and documented photographically. The onset of cataract was abrupt in all three patients, and resolved over a three- to 36-day period. Two patients had bilateral reversible cataracts, and in one of these patients the lenticular opacities were recurrent. Two of the patients had been taking oral corticosteroids. Temporary cataracts have been previously reported in patients with poor diabetic control. Diabetes mellitus had been diagnosed in only one of our patients. Three-hour glucose tolerance testing of the other two patients disclosed mildly increased one-hour blood glucose levels. We believe that reversible lens opacities may occur in subclinical diabetes mellitus with normal or only mildly increased blood glucose levels.

Retained nuclei after cataract surgery.

The authors reviewed the medical records of 36 patients in whom the nucleus or nuclear fragments were retained in the eye after cataract surgery. In 4 patients, there was no further surgery, and visual acuity deteriorated to counting fingers or worse (mean follow-up time, 14 months). Thirty-two patients underwent vitrectomy to remove the retained, unencapsulated nuclear material. Sixty percent (6 of 10) of patients in whom vitrectomy was performed after 3 weeks had chronic glaucoma on long-term follow-up, whereas this complication developed in only 18% (4 of 22) of patients in whom vitrectomy was performed in less than 3 weeks. Sixty-three percent (21 of 32) of vitrectomy patients had final visual acuity of 20/200 or better after removal of the retained nuclear fragments. The causes of the poorest visual outcome (less than 20/200) included 1 or more of the following: corneal decompensation, chronic inflammation, chronic glaucoma with optic atrophy, and retinal detachment.

Endogenous Candida endophthalmitis after intravenous anesthesia with propofol.

Propofol is an intravenous anesthetic agent that was approved by the US Food and Drug Administration in October 1989. It has gained rapid acceptance and is in widespread use. In June 1990, the Centers for Disease Control reported four clusters of postsurgical infections associated with the use of propofol. We describe one of those clusters, consisting of four cases of endogenous Candida albicans endophthalmitis. These infections occurred in nonimmunocompromised patients after they had undergone nonophthalmologic surgery in which propofol had been used as anesthesia. An investigation by the Centers for Disease Control concluded that the infections in these patients were due to extrinsic contamination of propofol during preparation for use at the hospital. Ophthalmologists should be aware of this new potential source of endogenous endophthalmitis.

Presumed intraocular nocardiosis in a cardiac-transplant patient.

A 44-year-old cardiac-transplant patient receiving immunosuppressive therapy developed a chorioretinal mass OS. The lesion was consistent with an ocular nocardial infection. The patient also developed a testicular abscess that was shown to contain N. asteroides after orchiectomy. Despite appropriate systemic treatment, the patient developed extensive subretinal scarring OS. This case report is the first to describe an opportunistic ocular infection with N. asteroides after cardiac transplantation.

Multiple evanescent white-dot syndrome. A report of eight cases.

Multiple evanescent white-dot syndrome (MEWDS) is a newly described clinical disease entity. The authors report on eight patients with findings characteristic of this syndrome. All of the patients were women and relatively young, with an average age of 28.2 years. Patients complained of unilateral black spots in their vision, with an initial visual acuity of 20/25 to 20/60. Examination showed characteristic small, white dots at the level of the retinal pigment epithelium (RPE). Fluorescein angiography demonstrated patchy hyperfluorescent defects at the level of the RPE with some late staining. All patients had good recovery of visual acuity with eventual fading of the white dots.

Treatment of proliferative diabetic retinopathy with panretinal cryotherapy.

Panretinal cryoablation was performed on 100 eyes with retinal neovascularization and vitreous hemorrhage. Of those 100 eyes, 70 had neovascularization and recurrent hemorrhage despite previous panretinal laser photocoagulation, and 30 eyes had media opacities precluding laser treatment. Sixty applications, random and focal, were placed in each eye. Forty-six percent of eyes achieved better visual acuity, 32% were unchanged, and 22% were worse. Eighty-three percent of eyes had vision of 20/200 or better. In eyes without prior laser photocoagulation, 83% were clear of vitreous hemorrhage following cryoablation, and in eyes with previous panretinal photocoagulation, 75% were free of vitreous hemorrhage after cryoablation.

Fenestrated sheen macular dystrophy.

Fenestrated sheen macular dystrophy is an autosomal dominant macular disorder characterized by the presence in the central macular zone of a golden sheen with tiny red fenestrations. Even in the later stages, only a mild functional disturbance has been observed. There were five patients manifesting this dystrophy in two generations of a family. They represent the third family so described.

Vitrectomy in Terson's syndrome.

Five patients with nonclearing vitreous hemorrhage associated with subarachnoid or subdural hemorrhages (Terson's syndrome) underwent pars plana vitrectomy. All six eyes of the five patients had postoperatively improved visual acuity and visual function. We recommend treating this rare syndrome with vitrectomy after careful preoperative ophthalmologic examination and a minimum observation period of six months to one year.

Subretinal neovascularization with geographic (serpiginous) choroiditis.

Three patients with geographic choroiditis developed subretinal neovascular membranes associated with subretinal hemorrhage and serous elevation of the retina. Proximity of the membrane to the foveal avascular zone prevented photocoagulation of the neovascular membrane in one patient. Central visual acuity remained 6/60 (20/200) despite systemic corticosteroid therapy. The neovascular membranes in the other two patients were obliterated by argon laser photocoagulation with preservation of central vision. The inflammatory process of geographic choroiditis can disrupt Bruch's membrane, allowing occasional choroidal vascular growth. Concomitant destruction of choroidal vessels may account for rarity of subretinal neovascularization in geographic choroiditis.

Giant drusen (astrocytic hamartoma) of the optic nerve seen with computerized axial tomography.

An EMI scan (computerized axial tomography) performed on a 75-year-old man with giant drusen (astrocytic hamartoma) of the left optic nerve clearly revealed a dense localized mass at the distal termination of the left optic nerve. The EMI scan proved to be an accurate, noninvasive technique for neuro-ophthalmologic diagnosis.