Endogenous endophthalmitis due to Fusarium: case report and review.

Endogenous fungal endophthalmitis is being increasingly recognized in susceptible individuals. We report a case of endogenous endophthalmitis due to Fusarium solani that occurred as the sole clinical manifestation of fungal disease in an immunocompromised host. Four previously reported cases of endogenous fusarial endophthalmitis are also reviewed. Two of these patients had no underlying disease and presented with isolated endophthalmitis, while two other patients had acute leukemia and presented with multiple organ involvement due to Fusarium. All three patients with leukemia, including our patient, were severely neutropenic at the time of diagnosis. Two of these three patients had fungemia. MICs of amphotericin B for fungal isolates ranged from 0.14 to 10 micrograms/mL. Despite abatement of the endophthalmitis after antifungal therapy and vitrectomy, the prognosis for immunocompromised patients remains guarded because of underlying disease.

Intravitreal penetration of oral ciprofloxacin in humans.

Nineteen patients about to undergo elective vitreous surgery received 1 oral dose of 750 mg of ciprofloxacin before surgery. Specimens of serum and vitreous were collected 90 minutes to 18 hours after drug administration and were assayed for antibiotic content with a microbiologic disk agar technique. From 4 hours and 50 minutes to 16 hours and 50 minutes after a single oral dose, ciprofloxacin reached intravitreal levels above its minimal inhibitory concentration for 90% of Staphylococcus epidermidis, Bacillus species, and Enterobacteriaceae. However, intravitreal levels never exceeded the MIC90 for Staphylococcus aureus and Pseudomonas.

Childhood immunization in the State of Qatar: Implications for improving coverage.

In Qatar, there is evidence of underuse of the immunization services despite easy access to health care. We therefore undertook a prospective study to determine the vaccination status and, more importantly, the reasons for inadequate immunization of a group of 255 preschool children attending the outpatient care facilities in Doha. A questionnaire was used to obtain relevant information, including parent's educational background. Sixty-six percent of the children were fully immunized for their age group, 12% were partially immunized, and 12% were not immunized. Eighty-eight percent had received their first dose of DPT/OPV, but only 57% had received their first booster by 18 months of age; 76% had received three doses of DPT/OPV. The main reasons for nonimmunized status were misinformation and lack of awareness in parents about vaccination. Parental oversight, misinformation, and medical deferral were the main reasons for partial immunization. Parents of unimmunized children were often illiterate. In Qatar, establishment of an aggressive ongoing public education campaign, as well as strict implementation of the World Health Organization's Expanded Programme on Immunization's policy of screenign all children at every health care contact for the need for vaccination, should substantially increase immunization coverage. Implementation of a recall system for defaulters should also lead to improved immunization rates.

Choroidal melanoma with pigment dispersion in vitreous and melanomalytic glaucoma.

A 39-year-old black man underwent enucleation of the left eye because of poor vision, ocular pain, and intractable glaucoma secondary to a choroidal tumor. Two diagnostic vitrectomies, performed 11 and 7 months before enucleation, had failed to disclose the proper diagnosis. Histologic diagnosis was necrotic malignant melanoma of the choroid with melanocytoma cells, extensive pigment dispersion throughout the eye, and melanomalytic glaucoma. Possible mechanisms of tumor necrosis are reviewed.

Macular degeneration in angioid streaks.

This study examines different clinical parameters and the occurrence of macular degeneration in a series of 110 patients with angioid streaks of the fundus. Among the parameters considered were: age of the patient at the time of ocular diagnosis, associated systemic disease, optic nerve drusen, peau d'orange appearance in the fundus, number of radiating angioid streaks as well as their length, width, and distance from the fovea. Statistically significant correlations were found between the occurrence of macular degeneration (of the exudative hemorrhagic type) and the following: angioid streak length, distance from the fovea, and the diffuse type or 'cracked egg-shell' fundus appearance.

Abnormal ocular head postures: Part IV.

All patients exhibiting the various types of abnormal head postures of ocular origin that were seen during the last two years are presented in order to determine the relative frequency of the different causes of these postures, and the purposes they serve. The treatment modality and results are also discussed. This manuscript is divided into four parts: Parts I, II, and III concern head postures in incomitant strabismus. In Part IV, head postures in Ciancia's syndrome, restrictions, and refractive errors are described.

Abnormal ocular head postures: Part III.

All patients exhibiting the various types of abnormal head postures of ocular origin that were seen during the last two years are presented in order to determine the relative frequency of the different causes of these postures, and the purposes they serve. The treatment modality and results are also discussed. The manuscript is divided into four parts: Parts I, II, and III concern head postures in incomitant strabismus. In Part IV, head postures in Ciancia's syndrome, restrictions, and refractive errors are described.

Abnormal ocular head postures: Part II.

All patients exhibiting the various types of abnormal head postures of ocular origin that were seen during the last two years are presented in order to determine the relative frequency of the different causes of these postures, and the purposes they serve. The treatment modality and results are also discussed. The manuscript is divided into four parts: Parts I, II, and III concern head postures in incomitant strabismus. In Part IV, head postures in Ciancia's syndrome, restrictions, and refractive errors are described.

Nonsimultaneous primary choroidal and cutaneous melanomas. Report of a case.

The authors report a patient with nonsimultaneous choroidal and cutaneous melanomas. The patient did not display the dysplastic nevus syndrome phenotype, and there was a negative family history for cutaneous or uveal melanomas. This sporadic case might suggest a common etiologic factor in the pathogenesis of multicentric malignant melanomas.

Abnormal ocular head postures: Part I.

All patients exhibiting the various types of abnormal head postures of ocular origin that were seen during the last two years are presented in order to determine the relative frequency of the different causes of these postures, and the purposes they serve. The treatment modality and results are also discussed. The manuscript is divided into four parts: Part I, II, and III concern head postures in incomitant strabismus. In Part IV, head postures in Ciancia's syndrome, restrictions, and refractive errors are described.

Uveal neovascularization at the ora serrata and pars plana.

Thirty-two eyes with uveal neovascularization at the ora serrata and pars plana were studied histopathologically. Chronic retinal detachment of various etiologies was the most frequently associated feature, present in 65% of the patients. In three eyes, the neovascularization took the form of an angiomatous lesion, whereas in the others, capillaries, arterioles, and venules were present. A history of glaucoma was found in 60% of the patients. Other associated findings included choroidal rupture, vitreous hemorrhage, and a history of cryotherapy. Uveal neovascularization at the ora serrata should be considered in the differential diagnosis of retinal angiomas, retinal telangiectasia, malignant melanoma, adult Coats's disease, peripheral proliferative retinopathies, and vitreous hemorrhage.

Ocular complications in strabismus fixus convergens.

Two cases of strabismus fixus are described. Histopathological examination of the eyeballs from both patients revealed the following complications of this rare disorder: ocular ischemia, atrophy of the optic nerve, and old central retinal artery occlusion. These complications are likely to be secondary to the mechanical stretching and torsion of the optic nerve with subsequent strangulation of its blood supply. Early surgical correction of strabismus fixus is recommended.

Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants.

Reported are 15 cases of age-related macular degeneration (AMD) complicated by massive subretinal and/or vitreous hemorrhage. Clinicopathologic correlation is presented in four of the seven cases studied histopathologically. Salient histologic findings include: subretinal and subretinal pigment epithelium (sub-RPE) fibrovascular scar in the posterior pole; discontinuities in Bruch's membrane with choroidal neovascularization; extensive hemorrhagic detachment of the RPE and sensory retina; and vitreous hemorrhage. In three cases, a choroidal artery, emerging from breaks in Bruch's membrane, had ruptured walls. The authors have reviewed the previously reported cases of AMD complicated by massive hemorrhage and found that 19% of the patients were taking Coumadin (warfarin) or aspirin treatment when the bleeding occurred. Forty percent had a positive history of systemic hypertension and cardiovascular diseases. Although the occurrence of hypertension is expected in the aged population with AMD, use of anticoagulants or antithrombotics by such patients may predispose them to serious ocular hemorrhagic complications.

Clinicopathologic correlation of lipidization and detachment of the retinal pigment epithelium.

A 49-year-old woman had a few small drusen-like lesions and one larger area of depigmentation in the right fundus. The pin-point lesions corresponded to single enlarged retinal pigment epithelial cells with lipid accumulation and the larger area represented a small, localized retinal pigment epithelial detachment (soft druse). Lipoidal degeneration of individual retinal pigment epithelial cells may be a mechanism of nodular drusen formation. The soft druse was associated with thickening of the basement membrane of the retinal pigment epithelium.

Malignant melanoma at the site of penetrating ocular trauma.

We document clinically and histopathologically the development of a uveal melanocytic tumor at the site of penetrating ocular trauma in a 34-year-old man. A metallic intraocular foreign body was extracted via the inferonasal pars plana with an electromagnet in February 1975. At that time no intraocular tumor was noted and the visual acuity returned to 20/20. The patient developed floaters in January 1981, at which time findings from fundus examination and needle biopsy of the lesion suggested the presence of a spindle-cell melanoma. The diagnosis was confirmed histopathologically following enucleation. The possible association between trauma and ocular melanoma is discussed.

Melanocytoma of the ciliary body: presentation of four cases and review of nineteen reports.

A clinical and histopathologic review of 23 cases of melanocytoma of the ciliary body discloses that the tumor is unilateral, extends into contiguous structures, slowly enlarges, and commonly undergoes necrosis. We report the clinical and histopathologic features of four cases of melanocytoma of the ciliary body, review the previously reported and presented cases, and discuss the differential diagnosis of melanocytoma of the ciliary body.

The retinopathy of primary hyperoxaluria.

The ophthalmoscopic and fluorescein angiographic findings in a seven-year-old boy with primary hyperoxaluria presented. The retinal findings in this condition have been reported previously in only ten patients. The fluorescein pattern which is considered to be very suggestive was reported previously in only one patient. In this report, ocular oxalosis is discussed, and the crystalline retinopathies are briefly reviewed.

Association of epibulbar choristomas with linear cutaneous nevi. Review of the literature.

The authors describe the association of epibulbar choristomas with linear cutaneous nevi of the epidermal and sebaceous variety in 24 cases reported in the literature. The choristomas are of the bilateral, extensive, multiple and complex type. The associated ocular and systemic findings include lid and uveal coloboma, lid choristoma, alopecia, convulsions and growth retardation.

Morphea of the eyelids.

Morphea, or localized scleroderma, of the eyelids is an uncommon disease. Morphea usually involves the thorax, trunk, lower and upper extremities, face, and genitalia. In the present report a patient with a biopsy-proven morphea of both upper eyelids is described. The salient histopathologic features included thinning of the epidermis with thickening and sclerosis of the collagen fibers in both the papillary and reticular dermis. There was a marked decrease in the fibrocytes. The eccrine sweat glands were entrapped by sclerotic collagen fibers. The pilosebaceous units were markedly decreased in number. There was a moderate lymphocytic infiltration in the dermis and a prominent lymphocytic perivasculitis. The clinical and histopathologic features of morphea are compared with those of lichen sclerosus et atrophicus.