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Prognosis of Endogenous Fungal Endophthalmitis and Utility of Ishibashi's Classification
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Jpn J Ophthalmol Vol 45: 429–435, 2001
Norihiro Nagai,* Hisao Ohde,* Yasuki Betsuin,* Shuji Matsukura,† Kazuki Kigasawa,† Yukihiko Mashima* and Yoshihisa Oguchi* *Department of Ophthalmology, Keio University School of Medicine; †Department of Ophthalmology, Tokai University School of Medicine, Tokyo, Japan PII S0021-5155(01)00355-0
Usefulness of Routine Ophthalmologic Examination for Cytomegalovirus Retinitis in Acquired Immunodeficiency Syndrome Patients Purpose: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. Methods: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4 T lymphocytes 50/ L or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). Results: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. Conclusions: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4 T lymphocyte counts are 50 cells/ L or less. (J Jpn Ophthalmol Soc 105:31–36, 2001) Mayumi Kitagawa,* Yoichi Nagata,† Yujiro Fujino‡ and Manabu Mochizuki§ *Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine; †Department of Ophthalmology, International Medical Center of Japan; ‡ Department of Ophthalmology, The Tokyo Kosei Nenkin Hospital; §Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School, Tokyo, Japan PII S0021-5155(01)00356-2
Prognosis of Endogenous Fungal Endophthalmitis and Utility of Ishibashi’s Classification Purpose: Prognostic evaluations of eyes with endogenous fungal endophthalmitis were made according to the classification proposed by Ishibashi. Patients and Methods: We surveyed endogenous fungal endophthalmitis cases at four Nihon University Hospitals and 20 branch hospitals. Sixty eyes of 34 patients were classified into five stages according to Ishibashi’s proposal, and therapeutic methods and visual prognosis in each stage were then evaluated. Results: Systemic antifungal drugs were efficacious in 82% of stage II and 69% of stage IIIa cases. Even among stage IIIb cases, antifungal drugs were efficacious in 42%. Among the unresponsive cases, only half had been given the maximum dosage of antifungal drugs. Half of the eyes in which vitrectomy was performed at stage IIIb achieved a postoperative visual acuity of 0.5 or better and none had a visual acuity of less than 0.03. Conclusion: Based on the above results, we concluded that systemic antifungal drugs should be administered at the maximum dosage in stage II and IIIa cases. If these eyes progress to stage IIIb despite the maximum dosage, vitrectomy is indicated. For stage IIIb eyes, the maximum dosage should be administered first. If the maximum dosage is not efficacious, vitrectomy should be carried out before progression to stage IV. (J Jpn Ophthalmol Soc 105:37–41, 2001) Yukihiro Sato, Shinobu Miyasaka and Hiroyuki Shimada Department of Ophthalmology, Surugadai Hospital of Nihon University, Tokyo, Japan PII S0021-5155(01)00357-4
A Case of Malignant Myoepithelioma in the Lacrimal Gland Background: A case of malignant myoepithelioma in the lacrimal gland is reported. Case: The patient, a 77-year-old male with increasing proptosis in the left eye, was referred to us. Steroid therapy was not effective; therefore, lateral orbitotomy was performed. Result: On pathological examination, the proper structure of actini was normal, but the cord of actini revealed the destruction layer tapering into the surrounding area. The tumor was composed of sarcomatoid
Jpn J Ophthalmol Vol 45: 429–435, 2001
Norihiro Nagai,* Hisao Ohde,* Yasuki Betsuin,* Shuji Matsukura,† Kazuki Kigasawa,† Yukihiko Mashima* and Yoshihisa Oguchi* *Department of Ophthalmology, Keio University School of Medicine; †Department of Ophthalmology, Tokai University School of Medicine, Tokyo, Japan PII S0021-5155(01)00355-0
Usefulness of Routine Ophthalmologic Examination for Cytomegalovirus Retinitis in Acquired Immunodeficiency Syndrome Patients Purpose: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. Methods: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4 T lymphocytes 50/ L or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). Results: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. Conclusions: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4 T lymphocyte counts are 50 cells/ L or less. (J Jpn Ophthalmol Soc 105:31–36, 2001) Mayumi Kitagawa,* Yoichi Nagata,† Yujiro Fujino‡ and Manabu Mochizuki§ *Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine; †Department of Ophthalmology, International Medical Center of Japan; ‡ Department of Ophthalmology, The Tokyo Kosei Nenkin Hospital; §Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School, Tokyo, Japan PII S0021-5155(01)00356-2
Prognosis of Endogenous Fungal Endophthalmitis and Utility of Ishibashi’s Classification Purpose: Prognostic evaluations of eyes with endogenous fungal endophthalmitis were made according to the classification proposed by Ishibashi. Patients and Methods: We surveyed endogenous fungal endophthalmitis cases at four Nihon University Hospitals and 20 branch hospitals. Sixty eyes of 34 patients were classified into five stages according to Ishibashi’s proposal, and therapeutic methods and visual prognosis in each stage were then evaluated. Results: Systemic antifungal drugs were efficacious in 82% of stage II and 69% of stage IIIa cases. Even among stage IIIb cases, antifungal drugs were efficacious in 42%. Among the unresponsive cases, only half had been given the maximum dosage of antifungal drugs. Half of the eyes in which vitrectomy was performed at stage IIIb achieved a postoperative visual acuity of 0.5 or better and none had a visual acuity of less than 0.03. Conclusion: Based on the above results, we concluded that systemic antifungal drugs should be administered at the maximum dosage in stage II and IIIa cases. If these eyes progress to stage IIIb despite the maximum dosage, vitrectomy is indicated. For stage IIIb eyes, the maximum dosage should be administered first. If the maximum dosage is not efficacious, vitrectomy should be carried out before progression to stage IV. (J Jpn Ophthalmol Soc 105:37–41, 2001) Yukihiro Sato, Shinobu Miyasaka and Hiroyuki Shimada Department of Ophthalmology, Surugadai Hospital of Nihon University, Tokyo, Japan PII S0021-5155(01)00357-4
A Case of Malignant Myoepithelioma in the Lacrimal Gland Background: A case of malignant myoepithelioma in the lacrimal gland is reported. Case: The patient, a 77-year-old male with increasing proptosis in the left eye, was referred to us. Steroid therapy was not effective; therefore, lateral orbitotomy was performed. Result: On pathological examination, the proper structure of actini was normal, but the cord of actini revealed the destruction layer tapering into the surrounding area. The tumor was composed of sarcomatoid