Document 0180
 DOCN  M95A0180
 TI    Involvement of anterior chamber angle structures in disseminated
       histoplasmosis: report of three cases.
 DT    9510
 AU    Font RL; Parsons MA; Keener MJ; Shaver RP; Foos RY; Department of
       Ophthalmology, Cullen Eye Institute, Baylor College; of Medicine,
       Houston, TX 77030, USA.
 SO    Ger J Ophthalmol. 1995 Mar;4(2):107-15. Unique Identifier : AIDSLINE
       MED/95315848
 AB    This study describes the involvement of anterior chamber (AC) angle
       structures in patients with disseminated histoplasmosis. The postmortem
       eyes from three patients (aged 33, 41, and 42 years, respectively) with
       disseminated histoplasmosis, two of whom had acquired immunodeficiency
       syndrome, were examined by light microscopy using hematoxylin-eosin,
       periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS)
       stains. Electron microscopy studies of the choroid were performed in one
       eye. Significant numbers of budding yeast forms of Histoplasma
       capsulatum measuring 2-5 microns in diameter were observed within the
       trabecular meshwork, Schlemm's canal and in the deep intrascleral
       plexuses. All eyes showed massive involvement of the choroidal
       vasculature, including the choriocapillaris. The organisms were observed
       freely as well as in small clusters within the cytoplasm of circulating
       monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary
       body (three eyes) contained many Histoplasma organisms. In one eye,
       several budding yeast were noted in an iris vessel and in occasional
       histiocytes within the ciliary muscle. Blood smears containing
       Histoplasma organisms were observed in two cases. None of the patients
       had an ophthalmologic examination prior to death. Involvement of the
       intravascular structures of the eye as well as the AC angle was observed
       in three patients with disseminated histoplasmosis. The fungus most
       likely reached the AC angle structures by direct hematogenous
       dissemination or via the aqueous humor by migration from vessels in the
       ciliary body and iris. An abnormal retrograde blood flow into the AC
       angle structures may have also played an important role. We suggested
       that the intraocular pressure be monitored in cases of suspected
       disseminated histoplasmosis to detect functional alterations indicative
       of a blockage in the outflow channels.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS  Adult  Anterior
       Chamber/*MICROBIOLOGY/ULTRASTRUCTURE
       Capillaries/MICROBIOLOGY/ULTRASTRUCTURE  Case Report
       Choroid/MICROBIOLOGY/ULTRASTRUCTURE  Ciliary Body/BLOOD
       SUPPLY/ULTRASTRUCTURE  Conjunctiva/BLOOD SUPPLY/ULTRASTRUCTURE  Eye
       Infections, Fungal/*PATHOLOGY  Female  Fungemia/*PATHOLOGY
       Histoplasmosis/*PATHOLOGY  Human  HIV Seropositivity/COMPLICATIONS
       Iris/BLOOD SUPPLY/ULTRASTRUCTURE  Male
       Monocytes/MICROBIOLOGY/ULTRASTRUCTURE  Retrospective Studies  Support,
       Non-U.S. Gov't  Trabecular Meshwork/MICROBIOLOGY/ULTRASTRUCTURE  JOURNAL
       ARTICLE

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