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Objective: The ability to diagnose cat-scratch disease (CSD) has been facilitated greatly by the recent isolation and characterization of Bartonella henselae (formerly genus Rochalimaea) and Afipia felis and by the subsequent development of specific enzyme-linked immunosorbent assay (ELISA) serologic tests. This study will help define the patterns of posterior segment ocular involvement in patients with confirmed CSD., Design: The study design is a retrospective case study and literature review., Participants: Two consecutive patients with acute visual loss from retinal manifestations of CSD participated., Interventions: The diagnosis was confirmed by B. henselae ELISA testing. Patients underwent extensive medical and ophthalmic investigations to exclude other causes of retinal and choroidal disease. Ophthalmic investigation included fluorescein angiography and visual field testing. One patient received antibiotic therapy with cefotaxime, then with ciprofloxacin, and was treated with oral prednisone. The other patient was improving for several weeks before oral doxycycline was given., Main Outcome Measures: The clinical syndromes observed were studied over time using visual acuity, visual field, and clinical findings. Data were collated with cases from the literature., Results: Unilateral neuroretinitis and an unusual macular retinitis developed in patient 1, as did bilateral small intraretinal white spots and a unilateral choroidal infiltrate that continued to develop while the patient received antibiotic treatment. Patient 2 had a branch arteriolar occlusion in relation to a perivascular retinal infiltrate and a few small, bilateral, intraretinal white spots. There was gradual resolution with visual improvement while the patient received the antibiotic treatment, although therapeutic efficacy could not be determined. Patient 1 also received oral corticosteroids. A detailed analysis of the literature placed these findings in context., Conclusions: An unusual, well-defined retinal opacification with features of both multiple retinal arteriolar occlusions and a low-grade retinitis was described. Several features also may occur in posterior segment CSD, including neuroretinitis, a retinal white spot syndrome, and focal choroiditis.

We report the histopathologic findings in a human eye enucleated after insertion of three nonmagnetic, metallic alloy tacks for treatment of a giant retinal detachment. Five months after surgery one of the tacks was detected in the anterior chamber. Two tacks remained in situ and induced a localized glial reaction, breaks in Bruch's membrane, disappearance of the retinal pigment epithelium and choriocapillaris immediately around the tack, and a variable extent of chorioretinal adhesion. The penetration of the tacks in the choroid and sclera was associated with a localized scar and only a mild inflammatory reaction, but all tacks themselves were free of inflammatory cells and degradation. The two tacks remaining in place were tolerated by the posterior segment. After comparing and contrasting our findings with those documented in the rabbit model, we conclude that overcoming dislodgement problems will require improved insertion techniques and tack design.

We successfully treated a patient with uveal effusion syndrome and abnormal sclera with a partial-thickness sclerectomy. Part of the sclera was immediately cultured, and the excised sclera and the cultured cells were examined by electron microscopy. The sclera demonstrated increased glycosaminoglycan-like deposits between the scleral fibers. The cultured scleral cells showed large intracellular glycogen-like deposits, which were not seen in cells cultured from two control scleras. These findings may be the result of a metabolic defect, which causes a thick, impermeable sclera in some cases of uveal effusion.

We performed a retrospective clinicopathological review of 124 patients with epithelial downgrowth seen over a 30-year-period at the Massachusetts Eye and Ear Infirmary. The purpose of this study was to determine predisposing factors in the development of epithelial downgrowth, diagnostic symptoms and signs, and the results of various types of treatments. The incidence of this condition after cataract surgery was 0.12%, decreasing to 0.08% over the latter decade. 82% of postsurgical patients with epithelial downgrowth presented to the ophthalmologist within one year following surgery, commonly complaining of decreasing visual acuity, red eye, and pain. The most common presenting signs of epithelial downgrowth were retrocorneal membrane, which was seen in 45% of patients, glaucoma in 43%, corneal oedema in 21%, and a positive Seidel test in 23%. We found that a variety of conditions predispose to epithelial downgrowth but that no one factor was present in all cases. Damage to the underlying endothelium, corneal stromal vascularisation, and stromal downgrowth appeared to be important events not emphasised in prior studies. The angle was partially or totally closed in 87% of enucleation specimens. Patients treated surgically underwent fewer enucleations than those treated medically or not treated.