ABSTRACT
A 38-year-old male patient experienced a unilateral visual acuity decrease to 20/60 and showed white dots at the level of the retinal pigment epithelial interface characteristic of multiple evanescent white dot-syndrome. Fluorescein angiography demonstrated early hyperfluorescent defects and some late staining. In spite of improvement of the visual acuity and the alterations of the fundus, an enlargement of the blind spot and some sharply demarcated depigmentations of the retinal pigment epithelium remain. This case shows, that already at the beginning of symptoms the characteristic white dots may be present. Enlargement of the blind spot and depigmentations of the retinal pigment epithelium may remain as defects after multiple evanescent white dot-syndrome.
Subject(s)
Fluorescein Angiography , Optic Nerve Diseases/diagnosis , Pigment Epithelium of Eye , Retinal Diseases/diagnosis , Scotoma/diagnosis , Adult , Color Vision Defects/diagnosis , Color Vision Defects/physiopathology , Electroretinography , Humans , Male , Optic Nerve Diseases/physiopathology , Pigment Epithelium of Eye/physiopathology , Remission, Spontaneous , Retinal Diseases/physiopathology , Scotoma/physiopathology , Visual Acuity/physiology , Visual Fields/physiologyABSTRACT
A 50 year old patient with non-diagnosed HIV-infection at onset of his illness developed impairment of vision and temporary double vision combined with severe hemianopsia. With normal fundus and suspicious Herpes simplex iritis therapy with Acyclovir was started. Primarily the patient showed a good response to the therapy and loss of vision could be prevented. After 4 weeks CMV-retinitis developed. In spite of Gancyclovir therapy manifestation of total loss of vision after 6 weeks. Autopsy demonstrated signs of simultaneous a CMV-infection of the retina and a herpes simplex-infection of the optic nerve combined with a Non-Hodgkin-Lymphoma of the optic tract.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Blindness/etiology , Brain Neoplasms/complications , Cytomegalovirus Infections/complications , Keratitis, Dendritic/complications , Lymphoma, Non-Hodgkin/complications , Opportunistic Infections/complications , Retinitis/complications , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/pathology , Blindness/diagnosis , Blindness/pathology , Brain/pathology , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Choroid/pathology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/pathology , Humans , Keratitis, Dendritic/diagnosis , Keratitis, Dendritic/pathology , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/pathology , Male , Middle Aged , Opportunistic Infections/diagnosis , Opportunistic Infections/pathology , Optic Nerve/pathology , Pigment Epithelium of Eye/pathology , Retina/pathology , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Retinal Detachment/pathology , Retinitis/diagnosis , Retinitis/pathology , Visual Fields/physiologyABSTRACT
As there is no generally accepted treatment for non-inflammatory anterior ischemic optic neuropathy, we have started a randomized, controlled clinical trial on isovolemic hemodilution. In this study all patients received a basic treatment of 75 mg of acetylsalicyclic acid daily. Patients were then randomly assigned to either a group without additional therapy or a group with isovolemic hemodilution. Isovolemic hemodilution was carried out over 6 weeks by several blood-letting procedures and replacement of volume by infusion of hydroxyethyl starch solutions (PCV down to 35-32%). So far, 21 patients have fulfilled the inclusion criteria (symptoms less than or equal to 30 days, no medical contraindications, no giant-cell arteritis), and since they matched for age, duration of symptoms, cardiovascular risk factors, they could be observed for at least 3 months. Although only 1 of 10 control patients hat better visual acuity after 3 months; 6 out of 11 hemodiluted patients had better vision after treatment (p = 0.024). These results indicate that isovolemic hemodilution most likely has a beneficial effect on the visual prognosis of patients with anterior ischemic neuropathy.
