Increased polymorphonuclear leucocyte rigidity in HIV infected individuals.

Aim: Individuals with human immunodeficiency virus (HIV) infection were evaluated for evidence of abnormal polymorphonuclear leucocyte (PMN) rigidity, which can alter capillary blood flow.

Methods: The transit time of individual PMN through 8 microm pores in a cell transit analyser was used as a measure of cell rigidity. PMN transit time was compared between HIV infected individuals (n=45) with and without CMV retinitis and HIV negative controls (n=17).

Immune recovery uveitis.

Potent antiretroviral therapy can result in substantial improvement in the immune function of patients with AIDS. In some patients with preexisting cytomegalovirus (CMV) retinitis, a consequence of this improved immune function is increased intraocular inflammation. This phenomenon, termed 'immune recovery uveitis', is characterized by anterior segment and vitreous inflammatory reactions.

New strategies for the management of AIDS-related CMV retinitis in the era of potent antiretroviral therapy.

The management of AIDS-related cytomegalovirus (CMV) retinitis is evolving because of newly available anti-CMV drugs and because of the effect of potent antiretroviral therapy. New management issues are related to the improved immune function that occurs with antiretroviral drug use and to associated increases in patient survival. Patients can be categorized on the basis of their history of exposure to antiretroviral drugs and to their immune status; these factors will influence choices between treatment options.

Control of visual symptoms in two men with birdshot retinochoroidopathy using low-dose oral corticosteroid therapy.

Purpose: To describe two men with birdshot retinochoroidopathy whose severe subjective visual symptoms were controlled by long-term use of low-dose oral corticosteroid therapy.

Method: Chart review.

Results: Vision improved subjectively in both men after initial treatment with oral prednisone (1 mg/kg/day) and remained stable while taking 5 mg daily or less of prednisone for periods of 54 and 81 months.

Quantitative cytomegalovirus DNA level in the blood and its relationship to cytomegalovirus retinitis in patients with acquired immune deficiency syndrome.

Objective: A pilot study was performed to determine whether relationships exist between changes in a quantitative solution hybridization assay for cytomegalovirus (CMV) DNA in the blood and development of CMV retinitis, development of nonocular CMV disease, or reactivation of pre-existing CMV retinitis lesions.

Design: Observational case series.

Participants: Two groups of human immunodeficiency virus-infected patients: 10 CMV antibody-positive patients with CD4+ T-lymphocyte counts of less than 50 ml and no CMV disease at baseline and 11 patients with CMV retinitis but no extraocular CMV disease at baseline.

pANCA antibodies in patients with anterior uveitis: identification of a marker antibody usually associated with ulcerative colitis.

A pANCA autoantibody (antineutrophil cytoplasmic antibody, perinuclear pattern) has been described in uveitis patients, but its correlation with systemic illnesses and the specific type of pANCA has not been defined. The goals of this study were to determine the (1) frequency of pANCA autoantibodies in uveitis, (2) systemic associations in the pANCA + uveitis patients, and (3) type of pANCA antigen recognized by the uveitis-associated autoantibody. Serum was obtained from 59 patients with anterior uveitis or panuveitis and from nonuveitis controls.

Chronic multifocal retinal infiltrates in patients infected with human immunodeficiency virus.

Purpose: To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.

Methods: We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.

Combination intravenous ceftazidime and aminoglycosides in the treatment of pseudomonal scleritis.

Background: Pseudomonal scleritis is a serious and potentially blinding infection that usually is resistant to medical management.

Methods: Results for three patients with pseudomonal scleritis who were treated with both topical anti-infectives and a combination of intravenous ceftazidime and aminoglycoside are presented in this case series.

Results: All three patients had a rapid response to the addition of combination intravenous drug therapy to topical therapy; eradication of the infection and healing of the ocular surface occurred within 8 weeks.

Uveitis as the only clinical manifestation of poststreptococcal syndrome.

Purpose: To report a case of streptococcal infection of the upper respiratory tract in which bilateral anterior uveitis was the only complication.

Method: Serologic documentation of post-streptococcal immune disease. The duration of inflammation was consistent with other forms of poststreptococcal immune disease.

Chiasmal infarction and sudden blindness caused by mucormycosis in AIDS and diabetes mellitus.

Purpose: To report rapidly progressive rhino-orbitocerebral mucormycosis in a 47-year-old woman with both diabetes mellitus and the acquired immunodeficiency syndrome (AIDS).

Method: Case report including postmortem examination of the eyes, orbit, and brain of a patient with rhino-orbitocerebral mucormycosis, diabetes mellitus, and AIDS.

Results: Invasion by hyphae of the Rhizopus species produced an occlusive vasculitis and massive infarction of the optic chiasm.

Recurrent ocular toxoplasmosis in patients treated with systemic corticosteroids.

Purpose: The authors discuss a possible relationship between systematic corticosteroid use and reactivation of ocular toxoplasmosis.

Methods: Patients were identified who developed foci of recurrent toxoplasmic retinochoroiditis while being treated with systemic corticosteroids. Case histories were reviewed retrospectively.

Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group.

Purpose: Most uveitis case series have come from tertiary care centers, and the relative frequencies of disorders they report may reflect referral bias. We sought information about the types of uveitis encountered in the general practice of ophthalmology.

Methods: We prospectively examined 213 consecutive cases of general uveitis, defined as intraocular inflammation other than cytomegalovirus retinopathy, seen by a group of community-based comprehensive ophthalmologists.

Local therapy for cytomegalovirus retinopathy.

Purpose: We sought to understand better the efficacy and risks of local therapies (direct placement of drug into the eye) for the treatment of cytomegalovirus retinopathy. This understanding can be used to design rational treatment regimens, to formulate indications for use of local therapy, and to establish criteria for assessment of future results in this area.

Methods: We collected information about local therapies through a review of published literature.

Association between Vogt-Koyanagi-Harada syndrome and HLA-DR1 and -DR4 in Hispanic patients living in southern California.

Background: Vogt-Koyanagi-Harada (VKH) syndrome is associated with human leukocyte antigen (HLA)-B54, -DR4, -DR beta 1*0405, -DQ4, and -DR53 in Japanese patients. Disease-associated HLA specificities may differ among races. This study examined HLA associations with VKH syndrome in Hispanic patients living in southern California, a racial subgroup at increased risk for the disease.

The effects of posterior subtenon injection of triamcinolone acetonide in patients with intermediate uveitis.

Purpose: Periocular injection of corticosteroids is a common treatment for vision loss in patients with intermediate uveitis. However, this treatment has the potential for serious side effects. We sought to determine the effects of such injections in a series of patients.

Dose-related difference in progression rates of cytomegalovirus retinopathy during foscarnet maintenance therapy. AIDS Clinical Trials Group Protocol 915 Team.

Purpose: A previous dose-ranging study of foscarnet maintenance therapy for cytomegalovirus retinopathy showed a positive relationship between dose and survival but could not confirm a relationship between dose and time to first progression. This retrospective analysis of data from that study was undertaken to determine whether there was a relationship between dose and progression rates, which reflects the amount of retina destroyed when progression occurs.

Methods: Patients were randomly given one of two foscarnet maintenance therapy doses (90 mg/kg of body weight/day [FOS-90 group] or 120 mg/kg of body weight/day [FOS-120 group] after induction therapy.

Corneal pharmacokinetics of topical clarithromycin.

Purpose: To evaluate the pharmacokinetics of topically applied clarithromycin, a new macrolide antibiotic, at various concentrations in a rabbit model.

Methods: Clarithromycin in dosages of 10, 20, and 40 mg/ml was administered topically every 2 hours for 48 hours to three groups of 16 New Zealand albino rabbits. Both corneas were treated.

The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS.

Background: The progressive outer retinal necrosis syndrome is a recently recognized variant of necrotizing herpetic retinopathy. This report characterizes more fully its clinical features and course.

Methods: Using standardized clinical criteria, patients with progressive outer retinal necrosis syndrome from four institutions were identified.

Ocular toxoplasmosis misdiagnosed as cytomegalovirus retinopathy in immunocompromised patients.

Background: Cytomegalovirus (CMV) and Toxoplasma gondii both cause necrotizing retinopathy in immunosuppressed hosts. Because of the high prevalence of serum antibodies to these agents in the general population and the risks associated with retinal biopsies, diagnosis of these infections is usually based on clinical findings alone, but the two infections can be confused with one another because of similar clinical features. Accurate diagnosis is critical, however, because both diseases are treatable but require different medical therapies.

Comparison of topical antibiotics for treating Mycobacterium fortuitum keratitis in an animal model.

The efficacy of three topical antibiotic treatments for Mycobacterium fortuitum (strain ATCC-6841) keratitis were compared in rabbits. Rabbits were treated with ciprofloxacin (3 mg/ml) or clarithromycin (20 mg/ml) or a combination of amikacin (100 mg/ml) and vancomycin (50 mg/ml). All three treatments significantly reduced the number of organisms in treated eyes compared to untreated, control eyes (all P values < .

Ocular tuberculosis.

In recent years tuberculosis has reemerged as a serious public health problem, raising the possibility that tuberculous eye disease may also become more prevalent. The predominant route by which tubercle bacilli reach the eye is through the bloodstream, after infecting the lungs. The pulmonary loci might not be evident clinically or radiographically.

Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients.

Cytomegalovirus retinopathy lesions in patients with the acquired immunodeficiency syndrome may continue to enlarge despite ganciclovir sodium treatment. In an historical cohort study, we used serial, masked retinal photographs to calculate progression rates for 14 ganciclovir-treated patients known to have disease progression and for 17 untreated patients. The median period of evaluation was 23.