Improvement in visual acuity in chronic aphakic and pseudophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine.

Ketorolac tromethamine 0.5% ophthalmic solution treatment was compared to placebo treatment in 120 patients with chronic aphakic or pseudophakic cystoid macular edema (six-month or more duration of distance visual acuity of 20/40 or less and angiographic evidence of cystoid changes) during a four- to five-month double-masked, multicenter study in which patients were randomly assigned. A statistically significant improvement in distance visual acuity (two lines or more) was observed in the ketorolac-treated group as compared to the placebo-treated group after 30 days (P = .038), 60 days (P = .017), and 90 days (P = .008) of treatment. This improvement in visual acuity remained statistically significant one month after cessation of treatment (P = .001). Nine ketorolac-treated patients and two placebo-treated patients demonstrated a decrease in visual acuity one month after treatment was discontinued. Seven of the nine ketorolac-treated patients experienced an improvement in visual acuity after retreatment as compared to none of the placebo-treated patients. This study offers evidence for a more optimistic outlook in the medical treatment of chronic aphakic and pseudophakic cystoid macular edema.

Improved detection and referral of patients with diabetic retinopathy by primary care physicians. Effectiveness of education.

We studied the effect of a 4-hour course in recognition and management of diabetic retinopathy on the ability of nonophthalmologist physicians to detect and to appropriately refer patients with sight-threatening diabetic retinopathy. Participants completed a written examination covering case management and performed a total of 340 dilated ophthalmoscopic examinations on selected patients before and 2 weeks following the teaching session. Accuracy of ophthalmoscopy was assessed by comparison with standardized grading of fundus photographs. Scores on the written examination increased from a mean of 49% to 78% correct. The likelihood of failing to detect and appropriately refer patients with proliferative or preproliferative retinopathy decreased from 60% to 15%. Similarly, for patients with maculopathy, the likelihood of failure to detect and to appropriately refer decreased from 83% to 15.6%. These data suggest that education may significantly improve the ability of nonophthalmologists to detect and to appropriately refer patients who are at risk for vision loss.

Surgical treatment for a case of postoperative Pseudallescheria boydii endophthalmitis.

Pseudallescheria boydii (P. boydii) is an uncommon ocular pathogen which previously has been identified in only 10 of 905 fungal isolates identified by the Sid Richardson Microbiology Laboratory at the Cullen Eye Institute of Baylor College of Medicine. Furthermore, only one case of postoperative P. boydii endophthalmitis and four cases of endogenous P. boydii endophthalmitis have been reported. Three of the four patients with endogenous endophthalmitis died within 4 weeks of diagnosis. We describe a second case of postoperative endophthalmitis due to this fungus. The infection was successfully eradicated following vitrectomy, corneoscleral resection, and patch graft, in addition to intraocular, topical, and oral antifungal medication. Although in vitro sensitivities are variable, P. boydii is known to be relatively resistant to amphotericin B. This points to the importance of proper cultures and sensitivities when treating cases of suspected fungal endophthalmitis. Unfortunately, the patient's eye became phthisical 6 months following the initial intervention.

Ocular trauma treated by vitreous surgery.

One hundred three consecutive patients with ocular trauma who were not candidates for conventional ocular surgical treatment were treated with vitreous surgical techniques. Follow-up of the patients from 12 to 60 months following vitreous surgery, with an average follow-up of 22 months. Data concerning the timing of vitreous surgery following injury, the location and severity of the injury, and other complicating factors that have an effect on eventual results are presented.

Update of ocular reticulum cell sarcoma.

Reticulum cell sarcoma involving the vitreous and the brainstem occurred in a 45-year-old man. He initially was seen with diplopia from a partial left-sided third cranial nerve palsy, which is rare. Later, a typical uveitis developed in the right eye. An initial diagnosis of brainstem glioma, based primarily on the computed tomographic scan findings and clinical history, was ultimately proved erroneous when the correct diagnosis was shown by the results of a cytologic examination of vitreous aspirate. Excellent visual response to a moderately high oral dose of steroids occurred, which has not been usual in other reported cases. Definitive cobalt (gamma) radiation therapy (6,000 rad to the brainstem and 4,000 rad to the vitreous) has produced a one-year remission at this time.

Sympathetic ophthalmia after pars plana vitrectomy-lensectomy for endogenous bacterial endophthalmitis.

A 71-year-old woman developed an endogenous bacterial endophthalmitis in her right eye. Because of the rapid progression she was treated by para plana vitrectomy-lensectomy and with antibiotics and corticosteroids. The patient improved after the antibiotic therapy. One month later she had a recurrence of the inflammatory signs in the same eye. Examination disclosed lens remnants in the vitreous. Because of the possibility of phacoallergic uveitis, she underwent a second vitrectomy. The corticosteroid dosage was increased. She did well until three months later when, while still taking corticosteroids, she noted loss of visual acuity in the left eye, accompanied by bilateral inflammatory signs. Sympathetic ophthalmia was suspected and the blind right eye was enucleated. The choroid was grossly unremarkable; the routine sections disclosed many inconspicuous foci of mononuclear infiltration. Tangential sections of flat-embedded choroid, however, showed ill-defined nests of epithelioid cells containing phagocytosed melanin, supporting the diagnosis of sympathetic ophthalmia. To our knowledge, this is the first published report of this complication after pars plana vitrectomy-lensectomy in the absence of nonsurgical trauma or other surgical procedures.

Bilateral retinal detachment following cytomegalovirus retinitis.

Bilateral retinal detachments developed in a renal allograft patient several months after the onset of cytomegalovirus retinitis. Laser photocoagulation was used to limit the posterior extent of one detachment until the detachment was surgically repaired. The thinned, atrophic retina that results from the necrotizing retinitis makes localization of retinal holes difficult and, in this case, contributed to the initial impression that these detachments were nonrhegmatogenous in origin.