Characteristics of Lisch nodules in patients with neurofibromatosis type 1.

PURPOSE: To assess the prevalence and location of Lisch nodules among patients with neurofibromatosis type 1. PATIENTS AND METHODS: This was a prospective observational case series in which 369 consecutive patients from a neurofibromatosis clinic participated. Predetermined inclusion and exclusion criteria were applied to these participants. The presence of Lisch nodules was determined by one of the authors (SMC). The percentage of patients with neurofibromatosis type 1 with Lisch nodules was calculated. Lisch nodules were characterized as being distributed superiorly, inferiorly, or equally in each eye. The percentage of eyes in each group was ascertained. RESULTS: Among patients of all ages with neurofibromatosis type 1, 63.2% had Lisch nodules, whereas 92% of postpubertal patients had Lisch nodules. Among eyes with Lisch nodules, 80% had an inferior distribution. CONCLUSIONS: This study corroborated previously reported data regarding the prevalence of Lisch nodules in patients with neurofibromatosis type 1 and found that Lisch nodules were predominantly located inferiorly on the iris. The authors propose that exposure to sunlight may be the mechanism for this distribution of hamartomatous nodules.

Severe pupil distortion following transchamber repair of a cyclodialysis cleft.

This report describes a potential complication following the repair of a traumatic cyclodialysis cleft in a pediatric patient using a novel technique. A healthy 11-year-old boy suffered a blunt traumatic tennis ball injury to his left eye. He underwent repair of a retinal dialysis with detachment shortly after the injury. Postoperatively, he developed persistent hypotony, shallow anterior chamber, and hypotony maculopathy. An occult cyclodialysis cleft was suspected. Examination under anesthesia revealed a small cyclodialysis deft. The cleft was closed by transchamber placement of prolene sutures across the cleft under direct visualization through a Tano lens. Postoperative course was complicated by severe pupillary distortion despite subsequent suture removal.

Endophthalmitis in patients with disseminated fungal disease.

BACKGROUND/PURPOSE: Fungal endophthalmitis caused by dissemination from extraocular fungal infections has been reported to vary between 9% and 45%. However, recent clinical experience disagrees with that. This study is an investigation of patients in an inner city teaching hospital, the risks associated with endogenous fungal endophthalmitis, and this incidence. METHODS: All ophthalmology consultations between February 1995 and August 2000 that might be associated with disseminated fungal infection were examined in a prospective manner. Patients were excluded if there was no evidence of a positive fungal culture from any site at any time. Visual symptoms were recorded along with ophthalmologic and systemic examination features. Information was gathered, including the identity of cultured organisms, the sites from which the organisms were obtained, and the patients' disposition. RESULTS: During this interval, 170 consultation requests contained the words "endophthalmitis" or "retinitis" and/or indicated concern about disseminated fungal infections. Extraocular fungal infections were found in 114 patients, but only 82 of them had evidence of systemic dissemination. Some patients had more than one organism. The following are listed in decreasing frequency of occurrence: Candida albicans, Torulopsis glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Aspergillus niger, and others. Only two patients had evidence of chorioretinitis and progressed to fungal endophthalmitis. CONCLUSIONS: Endophthalmitis was rare among these patients with known fungal infections. Less than 2% had any related ophthalmic manifestations. Nevertheless, since treatment can save vision, evidence of intraocular infection should be sought as eagerly as before.