Papillophlebitis and arteriolar occlusion in a pregnant woman.

Among the pathologic findings affecting the eye during pregnancy, microvascular abnormalities affecting both choroidal and retinal circulation have been reported in cases of complicated pregnancy. We report a case of papillophlebitis and arteriolar occlusion in a pregnant woman without any complications throughout her pregnancy. The patient was placed on glucocorticoids and her vision, visual fields and funduscopic appearance improved almost to normal. Despite the improvement with treatment, the contributing role of glucocorticoids in this case could not be fully determined. Papillophlebitis and arteriolar occlusion should be included among gestational-related vasculopathies.

Peripheral ulcerative keratitis associated with hideradenitis suppurativa.

Peripheral ulcerative keratitis (PUK) is a noninfectious inflammation and ulceration of the peripheral cornea. It may be idiopathic--i.e., Mooren's ulcer--or it may be associated with a variety of systemic disorders, including many collagen vascular diseases. We present a patient who had bilateral peripheral infiltrative and ulcerative keratitis in association with severe hideradenitis suppurativa (HS), a suppurative and cicatricial disease of the apocrine glands of the skin. The peripheral ulcerative keratitis was unresponsive to all routine treatment modalities, but it finally responded to immunosuppression by cyclophosphamide, given orally. To the best of our knowledge, there is only one report in the dermatology literature citing the association of hideradenitis suppurativa and interstitial keratitis.

Pseudo-Foster Kennedy syndrome in a patient with anterior ischemic optic neuropathy and a nonbasal glioma.

A 49-year-old woman with a 6-year history of headaches was found to have a pale right optic disc with narrowed retinal arterioles and a congested left optic disc. Her visual acuity was 20/20 in each eye with normal visual fields in May 1983. These findings were attributed to a previous attack of non-arteritic anterior ischemic optic neuropathy (AION). She had a normal neurologic examination and a normal head computed tomographic (CT) scan performed 2 years prior to her initial ophthalmologic evaluation. She was followed over the next 2 years without change in her fundus examination. In December 1987, after a generalized tonic-clonic seizure, she was found to have a large right frontoparietal mass without direct impingement on the optic nerves, or chiasm on neuroradiological studies. At this time she developed marked papilledema in the left eye with a pale optic disc in the right eye remaining unchanged. Histopathological diagnosis of malignant glioma was made. Two diseases, ischemic optic neuropathy and glioma, in one patient represents a bizarre example of the pseudo-Foster Kennedy syndrome.

Herpes zoster ophthalmicus, contralateral hemiplegia, and recurrent ocular toxoplasmosis in a patient with acquired immune deficiency syndrome-related complex.

A 42-year-old man presented with herpes zoster ophthalmicus on the right side. He was found to have acquired immune deficiency syndrome-related complex. Two weeks later he developed toxoplasmic retinochoroiditis in the left eye. He also presented later with left hemiplegia, which was probably caused by herpes zoster arteritis. Nine months after the retinal lesion resolved he developed another area of toxoplasmic retinochoroiditis adjacent to the first lesion. Herpes zoster may be the first presentation of acquired immune deficiency syndrome-related complex in a young healthy individual. Ophthalmologists are encountering patients with acquired immune deficiency syndrome who may have multiple organisms as the cause for their ocular infections and this might pose a treatment dilemma. The combination of herpes zoster ophthalmicus and ocular toxoplasmosis in this patient makes this case unusual.

Transient lenticular opacification following trabeculectomy.

Permanent lens changes may occur following filtering procedures for glaucoma, most often within a few years after the surgery. We present a case in which transient lenticular opacification occurred two days after trabeculectomy without intraoperative injury to the lens. The patient regained her preoperative vision 2 weeks postoperatively. We postulate that such reversible lenticular opacities may be due to changes in lens metabolism associated with hypotony.

Relationship of steroid dose to degree of posterior subcapsular cataracts in nephrotic syndrome.

Forty-five patients with nephrotic syndrome were included in our study. Of these, 30 received adrenocorticosteroid therapy and 15 did not. The ages of the patients ranged from 11 months to 27 years and the duration of steroid therapy from 2 1/2 years to 20 years. Seventeen patients (38%) showed posterior subcapsular cataract (PSC) formation and, of these, seven patients (41%) showed reversal of PSC. There was no statistical correlation between the total dose of steroids and the degree of PSC. An individual susceptibility may be an important factor in the production of PSC. None of the patients had visual acuity less than 20/30.

Retinal microangiopathy in pigmented paravenous chorioretinal atrophy.

This report describes an atypical case of pigmented paravenous chorioretinal atrophy, associated with focal progressive peripheral retinal microangiopathy, in a 51-year-old black female. The eyes were asymmetrically involved. Although several cases have been reported with typical features of this uncommon entity, none of them have been known to be associated with retinal microangiopathy. The occurrence of such microangiopathy supports the hypothesis that damage to the retinal photoreceptors may induce retinal microangiopathy, as suggested in other clinical and experimental studies.

Complete evulsion of the globe and optic nerve.

A 17-year-old boy had an evulsion of globe and optic nerve from an automobile accident. Computed tomography showed a severed optic nerve on the injured side. A visual field defect was demonstrated in the other eye.

Septic submacular choroidal embolus associated with intravenous drug abuse.

A 34-year-old male intravenous drug abuser had acute monocular loss of central vision nine days after fundus examination that had given normal results. He had a presumed septic submacular choroidal embolus in association with septic retinitis. No organism was recovered from the blood cultures. The lesion resolved with a residual chorioretinal scar in the macula and permanent loss of central vision.

The role of altered vascular permeability in recurrent uveitis.

Increasing ocular vascular permeability by topical application of prostaglandin E2 was found not to be a sufficient stimulus to induce the inflammation in either spontaneous immune disease in NZB or induced immune complex disease in rabbits.

Cilioretinal circulation and branch arterial occlusion associated with preretinal arterial loops.

Three patients had occlusion of preretinal loops and associated branch arterial occlusion. On fluorescein angiography all three eyes showed extensive cilioretinal circulation and that the occluded preretinal loops were part of the cilioretinal vascular anomaly. This supports the hypothesis that one form of preretinal arterial loop is associated with a malformation of the cilioretinal circulation.

Optic neuritis and systemic lymphoma.

A 26-year-old man with stage IV poorly differentiated lymphocytic lymphoma complained of visual loss of two weeks' duration. Examination revealed visual acuity of light perception in the right eye secondary to optic neuritis and other tests revealed the presence of lymphomatous leptomeningeal infiltration. Combined treatment with intrathecal methotrexate, prednisone, and whole brain radiation resulted in rapid long-lasting recovery of visual function of the right eye. The cerebrospinal fluid contained a large amount of thymus-derived lymphocytes and the subsequent clinical course observed with characteristic of T-cell or malignant lymphoblastic lymphoma.

Retinal varicosity in Klippel-Trenaunay syndrome.

A retinal varicosity in the Klippel-Trenaunay syndrome is observed and diagnosed in a 24-year-old female. Fluorescein angiography was used to illustrate and specify the nature of the retinal vascular anomaly.

Familial tapetoretinal degeneration and epilepsy.

Tapetoretinal degeneration is described in two siblings in association with generalized major motor seizures and intellectual impairment. Neither of these patients have the characteristic dysmorphic features or biochemical abnormalities seen in previously described cases, which are reviewed. Inheritance was probably autosomal recessive.

Ocular findings in patients with arteriovenous malformations of the head and neck.

The hospital charts of 71 patients with congenital arteriovenous malformation of the head or neck, excluding carotid-cavernous sinus fistulas, yiedled 25 patients, referred to the ophthalmology service for examination. Of these, 22 patients had ocular findings; additionally, 12 patients with visual complaints or ocular findings were not referred for ocular examination. Forty-seven percent of all patients had ocular signs and symptoms including subjective visual complaints, visual field loss, ophthalmic artery pressure changes, nystagmus and motility findings, orbital and ocular vascular abnormalities, and fundus changes including optic atrophy, hypoxic retinopathy, and papilledema. Every patient with known or suspected arteriovenous malformation of the head or neck should have a thorough ocular examination. The findings can generally be correlated with the anatomic location and size of the lesion.