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Ophthalmic Complications of Crack Cocaine
Letters to the Editor
Correction Tello C, Chi T, Shepps G, Liebmann J, Ritch R. "Ultrasound Biomicroscopy in Pseudophakic Malignant Glaucoma" (Ophthalmology 1993;100:1330-4). Figures 1A and 1B were inadvertently transposed in this article during the publication process. The editors regret this error.
References I. McHenry JG, Zeiter JH, Madion MP, Cowden JW. Corneal epithelial defects after smoking crack cocaine [letter]. Am J Ophthalmol 1989;108:732. 2. Zeiter JH, Corder DM, Madion MP, McHenry JG. Sudden retinal manifestations of intranasal cocaine and methamphetamine abuse [letter]. Am J Ophthalmol 1992;114:780-\. 3. Zeiter JH, McHenry JG, McDermott ML. Unilateral pharmacologic mydriasis secondary to crack cocaine [letter]. Am J Emerg Med 1990;8:568-9.
Note: Authors elected not
[0
respond.
Ophthalmic Complications of Crack Cocaine Dear Editor: We read with interest Sachs et aI's article entitled, "Corneal Complications Associated with the Use of Crack Cocaine" (Ophthalmology 1993;100:187-91) and applaud their effort in bringing further attention to this all too frequent problem of our inner cities. Rarely, a month goes by that we do not examine another patient with crack keratopathy.1 We also have seen patients with corneal ulcers after bilateral corneal epithelial defects secondary to crack cocaine. In one patient, a 23-year-old woman, a Streptococcus pneumonis corneal ulcer developed that responded to cefazolin while she was hospitalized. Once discharged, however, she was lost to follow-up. Poor follow-up is common in our patients with crack keratopathy and illustrates one of the social ramifications of cocaine abuse. We also have seen crack associated with central retinal artery occl usions, 2 unilateral pharmacologic mydriasis, 3 cranial nerve palsies, and optic neuropathy. Many crack babies have strabismus and nystagmus. The social effects of crack cocaine are too numerous to delineate. Frequently, our trauma patients were injured while trying to buy crack or have drug screens that are positive for cocaine. Undoubtedly, other crack-related syndromes will emerge. Crack-induced stroke results in the most severe problems that we currently encounter. In a young patient without a rheologic abnormality presenting with stroke, vasospasm secondary to crack cocaine must be ruled out, and it is incumbent upon the consulting neuro-ophthalmologist to consider this diagnosis. This may save the patient from many unnecessary tests. JOHN G . McHENRY, MD JOHN H. ZEITER, MD MATTHEW P. MADION, MD THOMAS C. SPOOR, MD Detroit, Michigan
Suprachoroidal Hemorrhage Dear Editor: We read with great interest the recent article by Reynolds and co-workers entitled, "Suprachoroidal Hemorrhage: Clinical Features and Results of Secondary Surgical Management" (Ophthalmology 1993;100:460-5). This retrospective study of 106 patients with suprachoroidal hemorrhages identified clinical features associated with a poor visual outcome. The authors should be commended on their fine work regarding such a large series of patients. The authors recommend that secondary surgical intervention should be considered in cases of suprachoroidal hemorrhage complicated by vitreous hemorrhage, retinal detachment and/or a vitreous incarceration. In general, we concur with these conclusions; however, we would like to clarify several comments made by Reynolds et al regarding our previous article. I We reported on a series of 18 patients with massive suprachoroidal hemorrhage (MSCH) with central retinal apposition. Four of these patients had an expulsive MSCH, and all were allowed to resolve spontaneously. Reynolds et al reported that none of these four patients had a final visual acuity greater than 20/200. This comment is somewhat misleading because the initial visual acuity in two of the patients ranged from 20/80 to 20/100. Both these patients experienced a late retinal detachment, one at 1 month and one at 12 months. These two patients, however, refused further surgery, and therefore their vision deteriorated. In addition, a third patient had a visual acuity of 20/100 after resolution of the MSCH, but visual acuity continued to deteriorate secondary to the progression of glaucomatous optic disc damage. Our last patient had an initial visual acuity of 3/200 after resolution of the suprachoroidal hemorrhage, but a branch retinal vein occlusion developed with deterioration of visual acuity.
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Correction Tello C, Chi T, Shepps G, Liebmann J, Ritch R. "Ultrasound Biomicroscopy in Pseudophakic Malignant Glaucoma" (Ophthalmology 1993;100:1330-4). Figures 1A and 1B were inadvertently transposed in this article during the publication process. The editors regret this error.
References I. McHenry JG, Zeiter JH, Madion MP, Cowden JW. Corneal epithelial defects after smoking crack cocaine [letter]. Am J Ophthalmol 1989;108:732. 2. Zeiter JH, Corder DM, Madion MP, McHenry JG. Sudden retinal manifestations of intranasal cocaine and methamphetamine abuse [letter]. Am J Ophthalmol 1992;114:780-\. 3. Zeiter JH, McHenry JG, McDermott ML. Unilateral pharmacologic mydriasis secondary to crack cocaine [letter]. Am J Emerg Med 1990;8:568-9.
Note: Authors elected not
[0
respond.
Ophthalmic Complications of Crack Cocaine Dear Editor: We read with interest Sachs et aI's article entitled, "Corneal Complications Associated with the Use of Crack Cocaine" (Ophthalmology 1993;100:187-91) and applaud their effort in bringing further attention to this all too frequent problem of our inner cities. Rarely, a month goes by that we do not examine another patient with crack keratopathy.1 We also have seen patients with corneal ulcers after bilateral corneal epithelial defects secondary to crack cocaine. In one patient, a 23-year-old woman, a Streptococcus pneumonis corneal ulcer developed that responded to cefazolin while she was hospitalized. Once discharged, however, she was lost to follow-up. Poor follow-up is common in our patients with crack keratopathy and illustrates one of the social ramifications of cocaine abuse. We also have seen crack associated with central retinal artery occl usions, 2 unilateral pharmacologic mydriasis, 3 cranial nerve palsies, and optic neuropathy. Many crack babies have strabismus and nystagmus. The social effects of crack cocaine are too numerous to delineate. Frequently, our trauma patients were injured while trying to buy crack or have drug screens that are positive for cocaine. Undoubtedly, other crack-related syndromes will emerge. Crack-induced stroke results in the most severe problems that we currently encounter. In a young patient without a rheologic abnormality presenting with stroke, vasospasm secondary to crack cocaine must be ruled out, and it is incumbent upon the consulting neuro-ophthalmologist to consider this diagnosis. This may save the patient from many unnecessary tests. JOHN G . McHENRY, MD JOHN H. ZEITER, MD MATTHEW P. MADION, MD THOMAS C. SPOOR, MD Detroit, Michigan
Suprachoroidal Hemorrhage Dear Editor: We read with great interest the recent article by Reynolds and co-workers entitled, "Suprachoroidal Hemorrhage: Clinical Features and Results of Secondary Surgical Management" (Ophthalmology 1993;100:460-5). This retrospective study of 106 patients with suprachoroidal hemorrhages identified clinical features associated with a poor visual outcome. The authors should be commended on their fine work regarding such a large series of patients. The authors recommend that secondary surgical intervention should be considered in cases of suprachoroidal hemorrhage complicated by vitreous hemorrhage, retinal detachment and/or a vitreous incarceration. In general, we concur with these conclusions; however, we would like to clarify several comments made by Reynolds et al regarding our previous article. I We reported on a series of 18 patients with massive suprachoroidal hemorrhage (MSCH) with central retinal apposition. Four of these patients had an expulsive MSCH, and all were allowed to resolve spontaneously. Reynolds et al reported that none of these four patients had a final visual acuity greater than 20/200. This comment is somewhat misleading because the initial visual acuity in two of the patients ranged from 20/80 to 20/100. Both these patients experienced a late retinal detachment, one at 1 month and one at 12 months. These two patients, however, refused further surgery, and therefore their vision deteriorated. In addition, a third patient had a visual acuity of 20/100 after resolution of the MSCH, but visual acuity continued to deteriorate secondary to the progression of glaucomatous optic disc damage. Our last patient had an initial visual acuity of 3/200 after resolution of the suprachoroidal hemorrhage, but a branch retinal vein occlusion developed with deterioration of visual acuity.
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