ABSTRACT
Posterior subcapsular (PSC) lens changes were found in 32 of 33 steroid-treated renal transplant patients examined with the slit lamp techniques of direct and retroillumination. Only one of 33 age-matched controls had any PSC changes. Six (18%) of the renal transplant patients were bilaterally surgically aphakic because of PSC cataracts that developed while the patient was receiving steroid therapy after transplant surgery. Steroid-induced PSC cataracts were associated with the presence of human leukocyte antigen (HLA) A1, but not with the patient's age, cause of renal failure, total dose of steroids, or duration of steroid therapy.
Subject(s)
Cataract/chemically induced , HLA Antigens/analysis , Kidney Transplantation , Methylprednisolone/adverse effects , Prednisone/adverse effects , Adolescent , Adult , Aged , Cataract/immunology , Child , Female , HLA-A1 Antigen , Humans , Male , Middle AgedABSTRACT
Two monocular normotensive patients with nonarteritic ischemic optic neuropathy and retinal ischemia unresponsive to steroid therapy were treated with intravenous norepinephrine. In both patients, improvement in vision began within minutes after moderate hypertension was produced. A third patient showed no response to this therapy in one eye with established ischemic optic neuropathy, but had prompt recovery of vision in the second eye early in the course of ischemic optic neuropathy. This patient returned with recurrent ischemic optic neuropathy more than 1 year later. At that time she was found to have essential hypertension. One patient could not be weaned from the norepinephrine infusion without recurrent visual loss. In the second patient, controlled hypertensive therapy restored visual acuity to 20/30 during two separate recurrences of ischemic optic neuropathy. Therapy of a later episode of ischemic optic neuropathy was delayed for 2 days, and vision did not improve with norepinephrine infusion. This eye subsequently became painful and required enucleation. Histopathological evaluation showed combined arterial and venous occlusions within the optic nerve and evidence of previous peripapillary choroidal vascular occlusion. Selected normotensive patients with ischemic optic neuropathy and retinal ischemia may benefit from controlled hypertensive therapy induced by norepinephrine infusion.
Subject(s)
Ischemia/drug therapy , Norepinephrine/therapeutic use , Optic Nerve Diseases/drug therapy , Optic Nerve/blood supply , Aged , Female , Humans , Male , Middle Aged , Optic Nerve Diseases/complications , Retinal Vessels , Vision Disorders/etiologySubject(s)
Eye/anatomy & histology , Renal Dialysis/adverse effects , Anterior Chamber/anatomy & histology , Cornea/anatomy & histology , Humans , Intraocular Pressure , Kidney Failure, Chronic/therapy , Lens, Crystalline/anatomy & histology , Refractive Errors/diagnosis , Refractive Errors/etiology , UltrasonographyABSTRACT
Four members of a family had the heriditary syndrome of dominantly inherited progressive optic atrophy and congenital sensorineural deafness. Hearing evaluations revealed that two members had a potentially treatable form of deafness.
