Although Cryptococcus neoformans and cryptococcosis have existed for several millennia, a century has passed since the discovery of this encapsulated yeast and its devastating disease. With the advent of the AIDS pandemic, cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality and a frequently life-threatening opportunistic mycosis among patients with AIDS. Both basic and clinical research have accelerated in the 1990s, and this review attempts to highlight some of these advances. The discussion covers recent findings, current concepts, controversies, and unresolved issues related to the ecology and genetics of C. neoformans; the surface structure of the yeast; and the mechanisms of host defense. Regarding cell-mediated immunity, CD4+ T cells are crucial for successful resistance, but CD8+ T cells may also participate significantly in the cytokine-mediated activation of anticryptococcal effector cells. In addition to cell-mediated immunity, monoclonal antibodies to the major capsular polysaccharide, the glucuronoxylomannan, offer some protection in murine models of cryptococcosis. Clinical concepts are presented that relate to the distinctive features of cryptococcosis in patients with AIDS and the diagnosis, treatment, and prevention of cryptococcosis in AIDS patients.

Cryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans.

Purpose:To evaluate the prevalence of the most common serious adverse events associated with intravitreous (IVT) injection.Methods:A systematic search of the literature via PubMed from 1966 to March 1, 2004, was conducted to identify studies evaluating the safety of IVT injection. Data submitted in

Risks of intravitreous injection: a comprehensive review.

Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery.

Macular edema. A complication of diabetic retinopathy.

Ocular Neovascularization with Retinal Vascular Occlusion-III: Incidence of Ocular Neovascularization with Retinal Vein Occlusion

Introduction Silicone rubber has been widely used as implant material in plastic surgery and in retinal detachment procedures. 1 Liquid silicone was first injected into the vitreous cavity of rabbits by Stone, 2 who reported that silicone fluids of various viscosities were well tolerated and produced "very little change in the rabbit eyes over a period of two years." He went on to predict that it might be possible to find a "viscosity" that would maintain the "clarity" of the vitreous and help in "replacing the retina." Recently, other investigators 3-5 have confirmed Stone's observations. However, their animal experiments emphasized the possibilities of complications. Everett 4 reported cataract formation following the injection of liquid silicone into the vitreous cavity of rabbits; Galavin 5 produced glaucoma by the injection of liquid silicone into the posterior chamber of the rabbit eye. The present study serves a dual purpose: (1) to report further

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/627022/archopht_68_5_005.pdf

The use of liquid silicone in retinal detachment surgery.

Introduction Chloroquine and its derivatives are being widely used today for the treatment of such diseases as disseminated lupus erythematosus, discoid lupus, light sensitivity eruptions, sarcoid, asthma, skin tumors, rheumatoid arthritis, and other collagen diseases. Corneal changes were noted soon after the introduction of these drugs, and have been well documented in the literature.1-14According to Hobbs, Eadie, and Somerville,20corneal changes occur in approximately one-third of patients on prolonged chloroquine therapy. Since these changes disappear after cessation of therapy, they are of relatively little clinical significance. However, the irreversible retinal changes recently observed by Hobbs, et al.18,20represent a grave complication of chloroquine therapy. These findings consist of impaired central vision, peripheral constriction of the visual fields, marked attenuation of the retinal vasculature, pigmentary changes of the macula, and in some cases, peripheral pigmentary changes. Hobbs, et al. have now reported 4 cases of such changes,

Chloroquine Retinopathy: A Report of Eight Cases with ERG and Dark-Adaptation Findings

Cryptococcosis, a systemic fungal disease caused byCryptococcus neoformansoften becomes perceptible to the patient only after localization in the central nervous system.1Headache is the most common initial complaint, but is usually associated with other symptoms, including mental and visual changes, nausea and vomiting, neck pain, feverishness, and weakness.2Sometimes such symptoms are a reflection of elevated cerebrospinal fluid pressure, and this is especially true for the ophthalmologic complaints. The ocular complications which have been reported include photophobia, diplopia, ptosis, amblyopia, nystagmus, ophthalmoplegia, anisocoria, papilledema, neuroretinitis, and primary optic atrophy.3In rare instances, clinically apparent cryptococcal infection may be localized to the eye3,12; however, most frequently eye involvement is either the result of direct extension to the optic nerve via the subarachnoidal space, or associated with widespread disseminated disease.1 Untreated, cryptococcal meningitis is almost always a fatal disease, sometimes with a prolonged course.4

Ophthalmologic complications of cryptococcal meningitis.

One hundred thirteen cases of tributary retinal vein occlusions were evaluated with none progressing to central vein occlusions. Sixteen patients had open angle glaucoma, or elevated intraocular pressures. Only one patient with macular edema regained a visual acuity of 20/20. More pronounced visual depressions were found with more proximal occlusion sites. Fourteen patients with macular edema and 30 with vitreous hemorrhages received photocoagulation with improved or stabilized visual acuities being the rule. Photocoagulation also appeared to prevent the development and recurrences of vitreous hemorrhages.

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Retinal Tributary Vein Occlusion: History and Management by Photocoagulation

Introduction Retinoschisis is the term used to describe a split in the sensory retina. In this condition a new cleavage plane develops within that part of the retina derived from the inner layer of the optic cup; whereas in the retinal detachment, fluid accumulates between those parts of the retina derived from the inner and outer layers of the optic cup, between the retinal receptors (rods and cones) and the pigment epithelium. Retinoschisis can occur at any level of the sensory retina, but most commonly the cleavage takes place at the outer plexiform layer, with the accumulation of a mucopolysaccharide-rich viscous fluid within the schisis cavity. As the schisis progresses, the neural elements of the retina are at first stretched and finally lysed producing absolute visual loss in the affected areas. Clinically an absolute visual field defect corresponds to the area of retinoschisis. The diagnosis of retinoschisis is best made

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=ophth&articleId=627702&pdfFileName=archopht_72_3_003.pdf

Edward Okun

Papers

The use of liquid silicone in retinal detachment surgery.

Chloroquine Retinopathy: A Report of Eight Cases with ERG and Dark-Adaptation Findings

Ophthalmologic complications of cryptococcal meningitis.

Retinal Tributary Vein Occlusion: History and Management by Photocoagulation

The role of photocoagulation in the management of retinoschisis.