Severe herpetic keratitis. I: Prevalence of visual impairment in a clinic population.

We report a prevalence study of the best visual acuity in the affected eye of 100 selected patients with herpetic keratitis seen during a two-year period. Sixty-two patients retained an acuity of 6/9 or better without requiring penetrating keratoplasty (PK). The prevalence of reduced visual acuity severe enough to warrant PK was 33%. Patients requiring PK for whom full clinical records were available suffered a mean of 6.8 episodes of keratitis. In this group of patients the vision of 18 fell from 6/6 to 6/60 over a mean period of 8.5 years. Once visual acuity was permanently reduced to 6/12, 78% of patients proceeded to lose vision to 6/60. Unilateral visual impairment occurs in at least a third of patients with severe herpetic keratitis. Once vision falls permanently to 6/12, the long-term prognosis for vision appears to be poor.     

Juvenile hypocalcemia provokes persistent electroencephalographic change in renally compromised rats

In view of the putative involvement of calcium in uremic encephalopathy and the critical importance of this element in juvenile development, we examined the effect of temporary restriction of dietary calcium intake on serum chemistry and the quantitative electroencephalogram (Q.EEG) in unilaterally 3/4 nephrectomized juvenile male Sprague-Dawley rats. Animals were renally infarcted at 22-26 days of age (50-74 g) and placed on one of two isocaloric dietary regimens: powdered normal rat diet (ND, n = 25) or low calcium diet (LCD, n = 8) for 30 days. At this time, ND animals showed normal serum chemistries, whereas LCD rats were hypocalcemic and azotemic with significantly elevated blood urea nitrogen (BUN) and serum creatinine concentrations and reduced renal creatinine clearance values. All animals thereafter received ND for 25-34 further days, during which time chronic Q.EEG electrodes were implanted. At the end of the common ND feeding period, serum chemistry values were equal and normal in both groups. The average theta/alpha ratio (TAR) of the overnight Q.EEG was assessed for 3 days. We found that the TAR of previously LCD animals was significantly elevated compared with ND rats. This indicates an encephalopathic slowing of the background rhythm of these animals. We conclude that, following restoration of a transient uremic and hypocalcemic episode induced by LCD feeding, the Q.EEG background frequency of juvenile renally impaired rats was abnormally slow after 30 days of ND feeding.     

Nutrient intake in insulin-dependent diabetic patients with incipient nephropathy

The onset of diabetic nephropathy is characterized by subclinical elevation of urinary albumin excretion, so-called 'microalbuminuria' (M). Dietary assessments were carried out in 15 insulin-dependent diabetic patients with persistent M and an equal number with persistently normal albumin excretion. The groups were matched for sex, age, duration of diabetes, body mass index, insulin dose and glycosylated haemoglobin; there were no significant differences in systemic blood pressure, glomerular filtration rate, blood glucose and serum albumin concentrations between the groups; retinopathy was significantly more frequent in patients with M. Diabetics with persistent M were found to consume a significantly larger amount of fat (expressed as grams and percentage of total energy) and a significantly smaller percentage of total energy as carbohydrate than patients with normal albumin excretion; total dietary energy was larger in those with persistent M, but the difference was not significant. No significant differences were found in protein and fibre intakes between the groups. Our findings suggest that an excess in the dietary consumption of fat relative to carbohydrate might play an important role in the pathogenesis of early nephropathy in insulin-dependent diabetes mellitus. We emphasize the importance of careful attention to nutrient intake in the prevention and treatment of diabetic complications.     

Anterior ischemic optic neuropathy in Buerger's disease

A 77-year-old man with a history of Buerger's disease developed an anterior ischemic optic neuropathy. This disease, while rare in the United States at the present time, is common in other parts of the world. None the less, this appears to be the first reported case of this type of optic neuropathy in a patient with documented Buerger's disease. A possible mechanism is suggested.     

Bilateral dacryops

The clinical, radiologic, and histopathologic findings of a case of bilateral dacryops is reported in a 49-year-old man. The patient presented with cystic masses located in superior lateral orbits and underwent bilateral excisions of these without any postoperative complications.