James H. Elliott

Mycotic Endophthalmitis in Drug Abusers

We diagnosed mycotic endophthalmitis by positive cultures in a 47-year-old man and a 42-year-old woman, both intravenous amphetamine users. Reinfection with a different fungal species was documented in one case. Rapid identification of the isolate, in vitro susceptibilities, selection of appropriate routes and dosages of antifungals, and the role of adjunctive corticosteroids are crucial factors in the management of these difficult cases. We prescribed antifungals and adjunctive corticosteroids, and our patients vision improved.

Hla Antigens in Recurrent Stromal Herpes Simplex Virus Keratitis

HLA-A, HLA-B, and HLA-C antigens were typed on 48 patients with recurrent herpes stromal keratitis. The HLA-Aw30 antigen occurred three times more frequently in patients with herpes stromal keratitis than in those who lack the Aw30 antigen. When the data for the probability of the HLA-Aw30 were corrected for the number of variables studied, the corrected P value was not significant. A previous report of an increased frequency of HLA-B5 with recurrent herpes keratitis was not confirmed by our study. No significant associations with the HLA-C antigens were noted. HLA-DR antigen typing of 25 herpes stromal keratitis patients indicated that the HLA-DRw3 antigen appeared to have an increased frequency in herpes stromal keratitis. However, the small sample size studied precluded interpretation of the increased phenotypic frequency and the possible association of HLA-DRw3 and herpes stromal keratitis needs further study.

Vidarabine Therapy of Complicated Herpes Simplex Keratitis

Patients with active herpetic epithelial keratitis who had toxic reactions or were resistant to idoxuridine received vidarabine. Only one of 35 cases of herpetic epithelial keratitis without stromal disease failed to heal. Of 21 patients with active epithelial keratitis complicating stromal keratitis or uveitis. 11 had complete reepithelialization by day 14. Two patients were removed from the trial as treatment failures. The remaining cases healed in 21 to 48 days. In most instances the stromal keratitis was inactivated when the epithelial ulcer healed. In our patients treated with vidarabine, healing of herpes simplex epithelial ulcers was biphasic: Stage 1, progression from an active to an inactive viral ulcer, and Stage 2, complete reepithelialization.

Optic Atrophy After Ocular Contusion

Case 1—A 10-year-old black boy was struck in the left eye with a rock. Two days later the visual acuity in that eye had decreased to light perception without projection. The eyelids and the globe were intact. A small hyphema was present, the intraocuxad lar pressure was 53 mm Hg, and the cornea was edematous. The left optic disk appeared normal with spontaneous venous pulsations. Roentgenograms of the orbit and optic foramen were normal. He was treated with absolute bedrest, sedation, topxad ical corticosteroids, and dichlorphenamide (Daranide). Seven days after the injury, the intraocular pressure was 7 mm Hg, the hyphema had cleared, and the fundus showed early pallor of the optic disk with slight dilatation of the retinal veins. Definite optic atrophy with a vision of counting fingers at one foot was present one month after the injury.