trimethoprim--sulfamethoxazole-drug-combination and Choroid-Diseases

We studied 21 patients with the acquired immunodeficiency syndrome and presumed Pneumocystic carinii choroidopathy. The lesions were characteristically yellow to pale yellow in color, appeared at the level of the choroid, and were found in the posterior pole. They varied in size from 300 to 3,000 microns, initially increasing in number before treatment and eventually resolving after systemic antimicrobial therapy. Of the 21 patients, 18 (86%) had received inhaled pentamidine as prophylaxis against Pneumocystis pneumonia. Visual acuity and visual field testing showed little evidence of retinal destruction. Survival after the diagnosis of the choroidopathy ranged from two to 36 weeks. Pneumocystic choroidopathy offers an easily accessible clue to disseminated Pneumocystis infection. When comparing drugs for Pneumocystis prophylaxis, careful ocular examination can provide one indicator of the relative efficacy of protection against extrapulmonary disease.

Topics: Acquired Immunodeficiency Syndrome; Adult; Choroid Diseases; Drug Administration Routes; Eye Infections, Fungal; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Pentamidine; Pneumocystis; Pneumonia, Pneumocystis; Prognosis; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Visual Fields

To report the successful treatment of ocular toxoplasmosis and present the use of multimodal imaging to describe the changes in ocular toxoplasmic lesions subsequent to treatment.. A 73-year-old female visited the clinic with decreased visual acuity in the left eye. Fundus examination showed severe vitreous haze with yellow-white infiltrates near the foveal center. Spectral-domain optical coherence tomography (SD-OCT) revealed disorganization of the retinal structure with markedly thickened choroid beneath the active lesion. Highly elevated serum titers of IgG antibodies against Toxoplasma gondii were observed. Topical and systemic steroids with oral Bactrim were administered after a diagnosis of ocular toxoplasmosis was made. After improvement in the severity of vitritis, structural en face swept-source optical coherence tomography (SS-OCT) imaging demonstrated diffuse choroidal dilation with many collateral vascular branches surrounding the active lesion. Eight intravitreal injections of clindamycin (1 mg/0.1 ml) were administered at 1- to 2-week intervals along with systemic antibiotics and steroids. After the treatment, the toxoplasmic lesion resolved to an atrophic chorioretinal scar. Dilated choroidal vessel size was normalized and collateral vascular branches were markedly constricted on structural en face SS-OCT images.. This is the first detailed report on the morphological changes in the choroidal vasculature surrounding ocular toxoplasmic lesions that were characterized using SS-OCT-A imaging. Multimodal imaging with SS-OCT-A can be valuable in clinical diagnosis as well as in clarifying the mechanism of choroidal structural changes in ocular toxoplasmosis.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Protozoan; Choroid Diseases; Clindamycin; Eye Infections, Parasitic; Female; Fluorescein Angiography; Humans; Immunoglobulin G; Multimodal Imaging; Retinal Pigment Epithelium; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Topics: Abscess; Amikacin; Amphotericin B; Cefotaxime; Choroid Diseases; Drug Therapy, Combination; Eye Infections, Bacterial; Fluorescein Angiography; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Vitreous Body

Topics: Aged; Anti-Infective Agents, Urinary; Choroid Diseases; Ciliary Body; Exudates and Transudates; Glaucoma, Angle-Closure; Hematuria; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Uveal Diseases

Nocardia infection of the eye is uncommon. A case of choroidal abscess due to Nocardia farcinica infection is presented, and the literature is reviewed.. A 41-year-old immunocompromised man with chronic myeloid leukemia developed a unilateral choroidal abscess. N. farcinica was isolated from a simultaneous subcutaneous abscess and both infections responded to systemic sulfonamide therapy.. Three weeks after discontinuation of the sulfonamides, the choroidal abscess recurred with involvement of the vitreous. The infection was brought under control after reinstitution of the same drug.. Nocardiosis is a multisystem disease that has high mortality and ocular morbidity rates. The eyes of immunocompromised patients should be examined frequently as early detection and administration of the proper antibiotics may reduce the risk of this life-threatening infection.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Marrow Transplantation; Choroid Diseases; Female; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Nocardia; Nocardia Infections; Recurrence; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

We investigated the mechanism of drug-induced transient myopia, anterior chamber shallowing, and secondary angle-closure glaucoma in a young woman.. Ultrasound biomicroscopy was performed and the effects of cycloplegic eyedrops and unilateral laser iridotomy were evaluated.. Cycloplegic eyedrops and unilateral laser iridotomy had no effect. Ultrasound biomicroscopy identified the presence of a supraciliary choroidal effusion that caused forward displacement of the lens-iris diaphragm, resulting in increased myopia, anterior chamber shallowing, and angle-closure glaucoma. Discontinuance of trimethoprim and sulfamethoxazole combination led to the complete resolution of the condition.. Idiosyncratic drug reactions may produce a supraciliary choroidal effusion, resulting in myopia and secondary angle-closure glaucoma from the induced forward shift in the position of the crystalline lens and ciliary body.

Topics: Adult; Anterior Chamber; Anti-Infective Agents; Choroid; Choroid Diseases; Ciliary Body; Exudates and Transudates; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Laser Therapy; Myopia; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Uveal Diseases