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Warfarin® Potassium for Impending Central Retinal Vein Occlusion
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Jpn J Ophthalmol Vol 43: 334–341, 1999
Miina Hiraoka and Yujiro Fujino Department of Ophthalmology, The University of Tokyo School of Medicine PII S0021-5155(99)00060-X
Warfarin® Potassium for Impending Central Retinal Vein Occlusion Purpose: We reviewed the records of 10 patients who had impending central retinal vein occlusion in order to judge whether anticoagulant treatment with warfarin potassium Warfarin® was indicated. Patients: Six men and four women, ranging in age from 25 to 83 (average 55) years were studied. Results: Of 6 eyes, retinal hemorrhage disappeared completely within 6 months. Four patients whose visual acuity was 0.1 or less at one month needed photocoagulation. Four other patients whose late venous circulation time at fluorescein angiography improved within 30 seconds had good visual prognosis. Three eyes of four patients aged 65 or older were not successful in regaining their visual acuity. Conclusion: Warfarin® was not effective for patients who had clearly lost their visual acuity and the elderly in this series. Late venous circulation time at fluorescein angiography was a useful index for this treatment. (J Jpn Ophthalmol Soc 103:124–128, 1999) Minoru Furuta, Tetsuju Sekiryu, Hironao Sato and Toshiyuki Fujiwara Department of Ophthalmology, Fukushima Medical University PII S0021-5155(99)00061-1
Histopathological Observations on Bullous Keratopathy After Argon-Laser Iridotomy Purpose: To elucidate histopathological mechanism of bullous keratopathy after argon-laser iridotomy (ALI). Case and Methods: The patient was a 60-year-old female who underwent penetrating keratoplasty because of bullous keratopathy after 2 years and 2 months of ALI. The corneal specimen was fixed with a mixture of 2.5% formalin and 1.0% glutaraldehyde, and examined under light and electron microscopes. Finding and Conclusion: Laser-damaged endothelium produced a large amount of basement membrane-like material beneath Descemet’s membrane. At the next stage, the severely damaged endothe-
lium lost its organellae and cell membranes, and fell off. The surrounding healthy endothelium migrated into the damaged area and produced a small amount of material like basement membrane which covered Descemet’s membrane. After that, stromal swelling, decrease of keratocytes, breaking and disappearance of Bowman’s membrane, epithelial edema, connective tissue accumulation beneath basal cells, and epithelial detachment occurred in the laser-damaged area (J Jpn Ophthalmol Soc 103:129–136, 1999) Ron-Jia Chen,* Akira Momose,† Shigekuni Okisaka‡ and Atsushi Mizukawa‡ *Eye and Ear Nose Throat Hospital of Shanghai Medical University; †Institute of Clinical Ophthalmology; ‡ Department of Ophthalmology, National Defense Medical College PII S0021-5155(99)00062-3
A Case of AIDS Complicated by Progressive Outer Retinal Necrosis Background: The retina may be involved in patients with acquired immunodeficiency syndrome (AIDS). Progressive outer retinal necrosis (PORN) is a liability. Case: A 46-year-old female had repeated exacerbations of pulmonary tuberculosis since 2 years before. Herpes zoster developed in her right trigeminal nerve area 2 weeks before, leading to a diagnosis of AIDS. She was referred to us for ophthalmological evaluation. Findings: Both eyes showed numerous yellowish white patches in the deeper retinal layers. The anterior chamber and the vitreous were almost intact. Herpes zoster virus was identified in the aqueous by the polymerase chain reaction method. Systemic acyclovir or ganciclovir failed to prevent rapid extension of fundus lesions, resulting in whole-layer necrosis of the retina. Retinal detachment with multiple breaks developed in both eyes within eleven days after the patient was first seen by us. The clinical course was different from acute retinal necrosis and was characteristic of PORN. Conclusion: This case illustrates that PORN may develop in patients affected by AIDS. (J Jpn Ophthalmol Soc 103:137–143, 1999) Machiko Shimakawa* and Nobutaka Sato† *Department of Ophthalmology, Tokyo Women’s Medical University, School of Medicine; †Department of Ophthalmology, International Medical Center of Japan PII S0021-5155(99)00063-5
Jpn J Ophthalmol Vol 43: 334–341, 1999
Miina Hiraoka and Yujiro Fujino Department of Ophthalmology, The University of Tokyo School of Medicine PII S0021-5155(99)00060-X
Warfarin® Potassium for Impending Central Retinal Vein Occlusion Purpose: We reviewed the records of 10 patients who had impending central retinal vein occlusion in order to judge whether anticoagulant treatment with warfarin potassium Warfarin® was indicated. Patients: Six men and four women, ranging in age from 25 to 83 (average 55) years were studied. Results: Of 6 eyes, retinal hemorrhage disappeared completely within 6 months. Four patients whose visual acuity was 0.1 or less at one month needed photocoagulation. Four other patients whose late venous circulation time at fluorescein angiography improved within 30 seconds had good visual prognosis. Three eyes of four patients aged 65 or older were not successful in regaining their visual acuity. Conclusion: Warfarin® was not effective for patients who had clearly lost their visual acuity and the elderly in this series. Late venous circulation time at fluorescein angiography was a useful index for this treatment. (J Jpn Ophthalmol Soc 103:124–128, 1999) Minoru Furuta, Tetsuju Sekiryu, Hironao Sato and Toshiyuki Fujiwara Department of Ophthalmology, Fukushima Medical University PII S0021-5155(99)00061-1
Histopathological Observations on Bullous Keratopathy After Argon-Laser Iridotomy Purpose: To elucidate histopathological mechanism of bullous keratopathy after argon-laser iridotomy (ALI). Case and Methods: The patient was a 60-year-old female who underwent penetrating keratoplasty because of bullous keratopathy after 2 years and 2 months of ALI. The corneal specimen was fixed with a mixture of 2.5% formalin and 1.0% glutaraldehyde, and examined under light and electron microscopes. Finding and Conclusion: Laser-damaged endothelium produced a large amount of basement membrane-like material beneath Descemet’s membrane. At the next stage, the severely damaged endothe-
lium lost its organellae and cell membranes, and fell off. The surrounding healthy endothelium migrated into the damaged area and produced a small amount of material like basement membrane which covered Descemet’s membrane. After that, stromal swelling, decrease of keratocytes, breaking and disappearance of Bowman’s membrane, epithelial edema, connective tissue accumulation beneath basal cells, and epithelial detachment occurred in the laser-damaged area (J Jpn Ophthalmol Soc 103:129–136, 1999) Ron-Jia Chen,* Akira Momose,† Shigekuni Okisaka‡ and Atsushi Mizukawa‡ *Eye and Ear Nose Throat Hospital of Shanghai Medical University; †Institute of Clinical Ophthalmology; ‡ Department of Ophthalmology, National Defense Medical College PII S0021-5155(99)00062-3
A Case of AIDS Complicated by Progressive Outer Retinal Necrosis Background: The retina may be involved in patients with acquired immunodeficiency syndrome (AIDS). Progressive outer retinal necrosis (PORN) is a liability. Case: A 46-year-old female had repeated exacerbations of pulmonary tuberculosis since 2 years before. Herpes zoster developed in her right trigeminal nerve area 2 weeks before, leading to a diagnosis of AIDS. She was referred to us for ophthalmological evaluation. Findings: Both eyes showed numerous yellowish white patches in the deeper retinal layers. The anterior chamber and the vitreous were almost intact. Herpes zoster virus was identified in the aqueous by the polymerase chain reaction method. Systemic acyclovir or ganciclovir failed to prevent rapid extension of fundus lesions, resulting in whole-layer necrosis of the retina. Retinal detachment with multiple breaks developed in both eyes within eleven days after the patient was first seen by us. The clinical course was different from acute retinal necrosis and was characteristic of PORN. Conclusion: This case illustrates that PORN may develop in patients affected by AIDS. (J Jpn Ophthalmol Soc 103:137–143, 1999) Machiko Shimakawa* and Nobutaka Sato† *Department of Ophthalmology, Tokyo Women’s Medical University, School of Medicine; †Department of Ophthalmology, International Medical Center of Japan PII S0021-5155(99)00063-5