Maurice F. Rabb » Superior Paracentral Scotoma

The patient is a 30 year old white male with a 3 day history of a superior paracentral scotoma in his right eye. His past ocular history was remarkable for an episode of "viral retinitis" 8 years previously, resulting in a large central scotoma OS. During that time, he was admitted for intravenous drug abuse, but states he has used nothing but occasional marijuana since that time. He has a history of hepatitis B infection during childhood.

Initial visual acuity on 4/9/92 was 20/40 OD and 20/400 OS. There were no anterior chamber or vitreous cells.

The patient's vision continued to deteriorate, and Gancyclovir was added. This was changed to Foscarnet to cover for a possible resistent CMV infection, and infectious disease added Ceftriaxone for possible Rickettsial disease.

Anti-viral (Acyclovir and Gancyclovir), anti-toxoplasmal (Pyrimethamine and Sulfadiazine) and anti-Rickettsial (Doxycycline) agents were given for encephalitis of unknown etiology and corticosteroids were given for the elevated intracranial pressure and seizure prophylaxis.