Posttraumatic endophthalmitis.

Nineteen consecutive cases of culture-proved posttraumatic endophthalmitis occurred. Over an eight-year period, 19 (7.4%) of 257 patients with penetrating trauma had endophthalmitis develop, and 19 (31.1%) of 61 cases of endophthalmitis were due to trauma. Eleven (10.7%) of 103 patients with intraocular foreign bodies had endophthalmitis develop. Final visual acuity was 20/200 or better in eight (42.1%) of 19 and 20/30 or better in five (26.3%) of 19 cases of posttraumatic endophthalmitis. Organisms cultured were similar to those in the other types of endophthalmitis, except that Bacillus species were seen only in posttraumatic endophthalmitis (five [26.3%] of 19). Virulent organisms or retinal breaks or detachments seen at the time of primary repair indicated poor prognoses.

Peripapillary subretinal neovascularization causing pseudoedema of the optic disc.

A patient with typical lesions of senile macular degeneration exhibited an apparent swollen disc in one eye. A leaking peripapillary subretinal neovascular membrane was found to be the cause of the disc edema. The experience with this case indicates that such a membrane should be considered in the differential diagnosis of the swollen disc, especially when macular degeneration is present.

Idiopathic vitritis.

Vitritis is a relatively common clinical finding, and a significant number of patients present with vitritis as the major or only finding. The records of 199 patients coded "vitritis" at the Bascom Palmer Eye Institute were reviewed. Forty-seven patients fit in the category of "idiopathic vitritis" and formed a relatively distinct group of predominantly elderly woman who complained of floaters or blurred vision. The visual acuities were usually good and the anterior segments were generally normal. They had diffuse bilateral vitreous inflammation and either a normal fundus or reactive changes such as cystoid macular edema or preretinal "cellophane" membranes. Extensive medical evaluations were usually unremarkable. This study helps identify a group of patients with a typical presentation and rather characteristic eye findings. Additional work will be necessary to establish the pathogenesis, the natural course, and the efficacy of treatment.

Surgical results in ocular trauma involving the posterior segment.

Of 106 eyes with trauma involving the posterior segment, 12 could not be repaired, 74 were treated with vitrectomy, and 20 without vitrectomy. Fifty-five eyes (52%) achieved functional success (defined as a final visual acuity of 6/30 [20/100] or better or as a postoperative improvement in visual acuity from light perception or worse to 6/240 [5/200] or better), 16 (15%) attained anatomic success (attached retinas and generally clear media) but were functional failures, and 35 (33%) were both anatomic and functional failures. The prognosis was better in cases with intraocular foreign bodies and worse in cases with retinal detachments, marked vitreous hemorrhage, and large scleral lacerations. Traumatic involvements of the lens did not appear to affect the prognosis. Prophylactic scleral buckling appeared to lessen the incidence of postoperative retinal detachment. The eyes that underwent vitrectomy within 14 days of the injury had a better final visual outcome than those that underwent later vitrectomy.

Ocular quinine toxicity.

A 25-year-old woman had no light perception in either eye 14.5 hours after ingesting 3.7 to 4.7 g of quinine. Fundus photographs showed mild venous distention and retinal haziness, but normal arteries. The electroretinogram, electrooculogram, and visual-evoked potential were all mildly abnormal. Two days after the patient ingested quinine, her visual acuity returned to 6/6 (20/20) with a markedly constricted visual field. The classic late fundus appearance of quinine toxicity, marked vascular narrowing, and disk pallor developed within six months. Visual fields remained constricted to 12 degrees with small temporal islands.

Hypertension in primary hyperparathyroidism: the role of the renin-angiotensin system.

In four out of seven patients with primary hyperparathyroidism, we have found elevated plasma renin activity (PRA) and blood pressure, both of which returned to normal following surgical correction of the hyperparathyroidism. However, PRA was normal in nonmotensive patients with primary hyperparathyroidism, those with hypercalcemia of other etiologies, and those with secondary hyperparathyroidism. These findings suggest that the renin angiotensin system may play a role in the etiology of the hypertension in primary hyperparathyroidism.