Search

To provide prompt visual rehabilitation and to reduce the need for repeated operations, we performed vitrectomy with silicone oil tamponade in 16 consecutive eyes with retinal detachments related to cytomegalovirus retinitis and acute retinal necrosis in 13 patients with acquired immunodeficiency syndrome. In all 16 eyes (100%), retinas were reattached with one operation. Preservation of ambulatory vision was achieved in six of eight eyes (75%; mean follow-up, 14.6 weeks). No patient with hand motion visual acuity or worse pre-operatively recovered ambulatory vision. Visual acuity recovery was limited by optic nerve disease in five eyes (31%). Silicone oil-related side effects did not adversely affect visual outcome in any eye. Six patients (46%) have since died (mean, 4.4 months postoperatively). These data indicated that successful surgical repair of these detachments can be consistently achieved with this approach. The prognosis for ambulatory vision is strongly related to preoperative visual acuity.

Chronic recurrent iridocyclitis in three eyes of two patients with ankylosing spondylitis was associated with posterior spillover of inflammatory cells into the vitreous cavity. Continued inflammation resulted in significant vitreous opacification in all three eyes. After pars plana vitrectomy (two eyes) and cataract extraction with subtotal vitrectomy (one eye), visual acuity improved and stabilized in all three instances. Ocular inflammation was not appreciably exacerbated by surgical intervention. Vitreous opacification did not recur after vitrectomy, but visual improvement was limited because of chronic cystoid macular edema.

Ring-shaped keratitis appeared in the left eye of a 37-year-old woman who had worn soft contact lenses for more than five years. The corneal ring began to appear within seven days of a central corneal abrasion. Gram staining of the patient's contact lens cleaning solution showed many gram-negative rods, and microbiologic investigations of the patient's soft contact lens and contact lens case disclosed Pseudomonas aeruginosa.There was no clinical or laboratory evidence of an infectious process. Prompt treatment with polymyxin B-bacitracin ointment and prednisolone acetate 1% eyedrops led to resolution of the opacity and a return to the patient's normal visual acuity. The P. aeruginosaendotoxin may have been transferred through the epithelial break into the superficial corneal stroma, leading to ring formation via endotoxin-initiated, properdin-mediated, antibody-independent complement activation.

• Twelve patients (17 eyes) with the acute retinal necrosis syndrome were analyzed with special reference to the development of an acute optic neuropathy. Six patients (9 eyes) without acute optic nerve involvement were treated with intravenous acyclovir sodium and/or vitreoretinal surgery (group 1). Six patients (8 eyes) fulfilling absolute and relative criteria for acute retinal necrosis optic neuropathy were treated with intravenous acyclovir as well as optic nerve sheath decompression, and, in addition, some of these patients also underwent vitreoretinal surgery. Despite more pronounced initial visual loss compared with group 1, six eyes in group 2 regained visual acuity of 20/400 or better. In contrast, only 2 of 9 eyes in group 1 maintained their entry level visual acuity, and the visual acuities of the remaining 7 eyes deteriorated to counting fingers or worse. Therefore, the acute optic neuropathy complicating the acute retinal necrosis syndrome appears to benefit from prompt recognition and surgical decompression of the intraorbital optic nerve meninges in conjunction with intravenous acyclovir.

• Subtotal pars plana vitrectomy was performed in four patients with chronic toxocaral endophthalmitis. In two instances, chronic intraocular inflammation proved unresponsive to intensive corticosteroid therapy, but improved dramatically following vitrectomy. In one patient, a dense retrolenticular membrane was removed, and intractable amblyopia was prevented. Vitrectomy relieved vitreoretinal traction involving the macula in two instances and cured a peripheral traction retinal detachment in a third. Information gleaned from these cases suggests new guidelines for the laboratory confirmation of ocular toxocariasis. Patients with toxocaral endophthalmitis may benefit from pars plana vitrectomy when chronic inflammation does not respond to medical measures or when such inflammation causes permanent structural changes that threaten or interfere with central vision.

• Two patients with acute retinal necrosis syndrome demonstrated enlarged computed tomographic images of the optic nerves, a previously undescribed manifestation of this disorder to the best of our knowledge. One patient, with the bilateral variety of this syndrome, demonstrated bilateral optic nerve enlargement and, in one eye, appeared to achieve visual improvement following an optic nerve sheath decompression. The second patient, with the unilateral variety of the syndrome, demonstrated only unilateral optic nerve enlargement. These observations suggest that the intraorbital optic nerve may be primarily or secondarily involved in the acute retinal necrosis syndrome.