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Biomedical subjects

Susan Lightman

Publications and source records attributed to Susan Lightman.

At least 37 records · Page 2Linked to original sources
PubMed2003

Vitreous aspiration needle tap in the diagnosis of intraocular inflammation.

PURPOSE: To determine the safety of vitreous aspiration needle tap as a clinical procedure and its usefulness in helping to distinguish between infective, inflammatory, and malignant causes of uveitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Data were collected for 53 patients who had undergone vitreous aspiration needle tap as an outpatient in the clinic. METHODS: These patients underwent vitreous aspiration needle tap using a needle and syringe for the following indications: (1) when masquerade syndrome or infective retinitis was the primary diagnosis; and (2) to diagnose or exclude infective or malignant entities in patients not responding to treatment. The result of the analysis of the biopsy specimen and any complications that arose from the procedure were determined. RESULTS: In this series, vitreous aspiration needle tap generated an adequate sample for the relevant investigations in 92% of cases. The initial diagnosis of intraocular malignancy or infection was confirmed in 40% of patients. The remaining patients were treated with immunosuppressives for the ocular inflammation and showed clinical improvement over the follow-up period. Multiple procedures were required in two patients to make the diagnosis of B-cell intraocular lymphoma and in two patients with acute retinal necrosis who were treated for the presenting clinical features. CONCLUSIONS: Vitreous aspiration needle tap would seem to be a safe clinical procedure, which has a high success rate in differentiating between infectious, inflammatory, and malignant causes of uveitis. It is a quick procedure that can be carried out at the first outpatient visit.

Adult↗
PubMed2003

Diabetic retinopathy.

Diabetic retinopathy is the principal cause of irreversible blindness in patients of working age in the industrialized world (1,2). For some types of retinopathy (e.g., proliferative disease), effective treatment in the form of laser photocoagulation has been available for more than 20 years, but many patients seek help too late when treatment is no longer effective. Macular edema, which is much more common in patients with type 2 diabetes mellitus, may be the presenting sign and therefore may already be established at diagnosis. If vision is significantly reduced, current treatment options are often ineffective. Screening of diabetic persons for early signs of retinopathy, which are treatable, improves the visual prognosis. Medical factors such as good blood glucose control, management of hypertension, and regulation of blood lipid levels are also considered to be of major importance.

Comorbidity↗
PubMed2003

Pseudo-hypopyon as the presenting feature in B-cell and T-cell intraocular lymphoma.

The clinicopathologic correlation of two patients with primary intraocular lymphoma is described, both of whom had a rare and unusual presentation of hypopyon uveitis. Sampling of aqueous fluid proved the cytopathologic diagnosis of B-cell lymphoma in the first patient. In the second patient an iris biopsy confirmed a T-cell lymphoma. The samples were examined using haematoxylin and eosin, and immunohistochemical stains. These patients were diagnosed with primary intraocular lymphoma on initial presentation with hypopyon uveitis. Secondary glaucoma was noted in the patient with T-cell lymphoma. Both cases appeared confined to the eye and initially responded favourably to aggressive chemotherapy and radiotherapy, but later went on to develop systemic involvement. Clinicians should be aware of this dramatic mode of presentation, which is unusual for ocular lymphoma.

Adult↗
PubMed2003

Visual loss in sarcoid-related uveitis.

PURPOSE: To assess the visual acuity outcome after treatment, in patients with differing types of uveitis associated with sarcoidosis, and to determine the types of sight-threatening complications. METHODS: This was an retrospective, non-comparative, interventional study of patients who had uveitis with a confirmed diagnosis of sarcoidosis and a minimum follow-up duration of 6 months from presentation. The worst affected eye at presentation was selected for the study. Complications causing impaired vision were documented, changes in visual acuity after completion of treatment were measured, and the risk of 'poor outcome' (visual acuity 6/12 and less) was compared in the various types of uveitis, using 'exact' multiple logistic regression to control confounding by other prognostic factors. RESULTS: Seventy-five patients were studied. The spectrum of ocular inflammation in sarcoidosis is wide. Presentation may be acute and non-granulomatous or chronic and granulomatous with posterior segment involvement being varied. Poor visual outcome was significantly more frequent in multifocal choroiditis (5/7, 71.4%), and in panuveitis without multifocal choroiditis (13/28, 46.4%), compared to only 3/24 (12.5%) patients with anterior uveitis. The excess risks remained significant after adjustment for confounding effects of other prognostic factors including age, sex and manifest systemic sarcoidosis. Causes of visual loss were cataract, glaucoma, macular oedema, vitreous haemorrhage and retinal detachment. CONCLUSION: Multifocal choroiditis is a less common manifestation of uveitis associated with sarcoidosis but appears to be associated with a worse visual prognosis despite immunosuppressive therapy.

Adult↗
PubMed2003

Long-term efficacy of mycophenolate mofetil in the control of severe intraocular inflammation.

PURPOSE: To assess whether the previously demonstrated short-term efficacy of the immunosuppressant mycophenolate mofetil (MMF; CellCept, Roche) is maintained in the long-term management of refractory uveitis. METHODS: The study was an open-label, non-comparative retrospective series of 14 patients with refractory uveitis and treated with MMF for a mean of >33 months. Mycophenolate mofetil was given at a dosage of 1 g (oral) twice daily. Indications included prednisolone reduction, additive agent with cyclosporin, or replacement therapy (azathioprine or methotrexate). The intraocular inflammatory response, side-effects, and toxicity were monitored. RESULTS: Intraocular inflammation remained under control in 10 patients, unchanged in three and deteriorated in one patient. Transient side-effects included tiredness, headache and dizziness (one patient each, lasting less than 2 weeks from the time of MMF introduction). Mycophenolate mofetil was stopped in one patient because of absence of prolonged clinical improvement. Vision improved in 25% (7 eyes), did not change in 50% (14 eyes), but was reduced in 25% (7 eyes). CONCLUSIONS: Mycophenolate mofetil is safe for long-term usage and is recommended for treatment of refractory panuveitis or posterior uveitis with uncontrolled inflammation despite high prednisolone maintenance dosage (>15 mg/day) or toxicity or lack of efficacy of other immuno-suppressive agents. However, MMF is less effective for refractory uveitis unresponsive to azathioprine.

Adult↗
PubMed2003

Cystoid macular edema in uveitis.

Cystoid macular edema (CME) can cause profound visual loss and is one of the major causes of legal blindness in patients with uveitis. It can complicate virtually any type of acute or chronic, anterior or posterior uveitis. When mild and of short duration, CME may respond to treatment used to control the intraocular inflammation. However, patients may need more aggressive treatment with local and systemic steroid therapy and other immunosuppressive drugs. Unfortunately, CME may become refractory to all currently available therapies and result in severe visual loss.

Humans↗
PubMed2003

HIV/AIDS and the eye.

Explore the source record for details and available documents.

AIDS-Related Opportunistic Infections↗
PubMed2003

Retinal detachment in cytomegalovirus retinitis: intravenous versus intravitreal therapy.

PURPOSE: To compare the rate of retinal detachment in a group of patients treated with intravitreal ganciclovir to the rate of retinal detachment in a group of patients treated with systemic ganciclovir. METHODS: A retrospective non-randomized comparative case series was conducted. The participants were 186 consecutive patients with cytomegalovirus (CMV) retinitis treated at two centres over the period from June 1990 to May 1997. Of the 186, 133 patients had systemic therapy of whom 113 had intravenous ganciclovir or foscarnet and 20 had oral ganciclovir, and 53 patients had intravitreal induction and maintenance therapy. The main outcome measure was the rate of retinal detachment, which was calculated using person-months-at-risk denominators. The effect measure used in the main comparative analysis was the hazard ratio obtained from multiple regression using the Cox proportional hazards model. RESULTS: Retinal detachment occurred in three of 53 patients in the intravitreal therapy group, one of 20 patients receiving oral maintenance therapy and 21 of 113 patients receiving intravenous maintenance therapy. The risk of retinal detachment with systemic therapy was 14-fold higher than with intravitreal therapy (P < 0.001)and up to fourfold higher with oral maintenance therapy. CONCLUSIONS: Intravitreal therapy offers a significant advantage over systemic therapy in the treatment of CMV retinitis by substantially reducing the risk of CMV-related retinal detachment.

AIDS-Related Opportunistic Infections↗
PubMed2002

The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators.

OBJECTIVE: We aimed to develop consensus-based recommendations for streamlining medical communication among various health care professionals, to improve accuracy of diagnosis and treatment, and to facilitate future investigations for mucous membrane pemphigoid. PARTICIPANTS: Because of the highly specific nature of this group of diseases, the 26 invited participants included either international scholars in the field of mucous membrane pemphigoid or experts in cutaneous pharmacology representing the 3 medical disciplines ophthalmology, oral medicine, and dermatology. EVIDENCE: The first author (L.S.C.) conducted a literature search. Based on the information obtained, international experts who had contributed to the literature in the clinical care, diagnosis, and laboratory investigation for mucous membrane pemphigoid were invited to participate in a consensus meeting aimed at developing a consensus statement. CONSENSUS PROCESS: A consensus meeting was convened and conducted on May 10, 1999, in Chicago, Ill, to discuss the relevant issues. The first author drafted the statement based on the consensus developed at the meeting and the participants' written comments. The draft was submitted to all participants for 3 separate rounds of review, and disagreements were reconciled based on literature evidence. The third and final statement incorporated all relevant evidence obtained in the literature search and the consensus developed by the participants. The final statement was approved and endorsed by all 26 participants. CONCLUSIONS: Specific consensus-based recommendations were made regarding the definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators for mucous membrane pemphigoid. A system of standard reporting for these patients was proposed to facilitate a uniform data collection.

Humans↗
PubMed2002

Orbital lymphoma misdiagnosed as scleritis.

OBJECTIVE: To describe two patients in whom orbital lymphoma was misdiagnosed and treated as scleritis. DESIGN: Two case reports with clinicopathologic correlation. METHODS: Each patient underwent clinical, radiologic, and histologic assessment. MAIN OUTCOME MEASURE: Histologic confirmation of the diagnosis of orbital lymphoma. RESULTS: The two patients who had been diagnosed and treated as having scleritis were found to have orbital lymphoma. CONCLUSION: The differential diagnosis for scleritis should include lymphoma.

Aged↗
PubMed2002

Developments in the treatment of uveitis.

Uveitis remains a challenging field to the ophthalmologist as the disease causes significant morbidity and the use of traditional forms of treatment is restricted by limited effectiveness and considerable side effects. This article explores new agents used in the treatment of uveitis as well as the potential of agents used successfully in experimental uveitis. This paper also reviews agents in use for a long time but now used in novel ways.

Adjuvants, Immunologic↗